Internal hernias are very rare in clinical practice. Because of a wide range of symptoms that can sometimes be non-specific, surgeons often disregard internal hernias in the spectrum of differential diagnosis in acute abdomen. Finding the diagnosis before an internal hernia causes an acute abdomen is sometimes difficult despite modern diagnostic tools. Reason for diagnosis delay is mostly because of wide range of symptoms and variable time period of abdominal pain before patients visit the physician. Furthermore, the delayed diagnosis can put patients in dangerous life threatening condition because internal hernias can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded so internal hernias presenting as acute abdomen may need operations as soon as possible. Performance of image studies could easily lead to a specific diagnosis and the best surgical strategy. Occasionally, an urgent laparotomy is the only diagnostic procedure and treatment. Here we present four patients with developed acute abdomen due to internal hernia and a course of treatment along with a review of the literature.