The study is devoted to the analysis of immediate causes of death in patients against the background of purulent complications after urgent abdominal pathology. The aim of the work is to determine the immediate causes of death of patients with purulent complications against the background of urgent abdominal pathology, as well as to identify patterns of postmortem pathomorphological changes in this category of patients. Materials and methods. The retrospective study analyzed data from 569 autopsy reports of patients who died in 2024 in Penza from urgent abdominal pathology. Among them, 160 (28.1 %) deceased patients had purulent complications during their lifetime against the background of the underlying disease. Most of the deceased (62.5 %) were over 60 years old. The most common underlying disease from the category of urgent abdominal pathology, leading to purulent complications, was acute cholecystitis (40 %). Results. Analysis of thanatogenesis revealed that the leading cause of death was peritonitis, often complicated by multiple organ failure, abdominal sepsis, and pneumonia. Microscopic examination revealed characteristic changes in the liver, kidneys, lungs, and heart associated with abdominal sepsis, including focal necrosis, interstitial inflammation, and microcirculatory disturbances. Age and gender characteristics of the course of purulent complications of urgent abdominal pathology were determined: severe sepsis occurred more often in men, and myocardial damage in women. Conclusion. The obtained data emphasize the importance of early diagnosis and treatment of urgent abdominal pathology, especially in elderly patients, taking into account age and gender characteristics to prevent purulent complications and improve treatment outcomes.