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Abstract Background In Tanzania, triphasic abdominal Computed Tomography (CT) is a more accessible and non-invasive alternative for diagnosing esophageal varices, though its accuracy has not been thoroughly evaluated, therefore this study aimed to determine the diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices using esophagogastroduodenoscopy (OGD) as the gold standard among patients with upper gastrointestinal bleeding at Muhimbili National Hospital (MNH). Methods This cross-sectional study was conducted at MNH from January 2021 to May 2023. We sampled upper gastrointestinal bleeding patients who underwent both OGD and triphasic abdominal CT using non-probability consecutive sampling. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of triphasic abdominal CT were assessed against OGD findings. Results In a study of 200 participants, esophageal varices were detected in 54% by OGD and 53.5% by CT. We observed 105 true positives, 2 false positives, 90 true negatives, and 3 false negatives. Triphasic abdominal CT demonstrated a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, NPV of 96.8%, and an accuracy of 97.5%. Extraluminal findings included portal venous thrombosis in (22%), splenic collateral (51.5%), ascites (32%), hepatocellular carcinoma (13%), and periportal fibrosis (32%). Conclusion Triphasic abdominal Computed Tomography can be used as a reliable and non-invasive alternative modality for diagnosing and screening esophageal varices in resource-limited settings.