Acute mesenteric ischemia is an abdominal emergency with high mortality and devastating morbidity. Perioperative mortality is 20% to 80%, depending upon the etiology of the acute process, and the overall mortality rate remains above 60%. In acute mesenteric ischemia, initial tissue injury occurs as a result of compromised end-organ perfusion. Secondary injury at the cellular level likely occurs through amplification of an inflammatory response with free-radical generation during reperfusion. Acute mesenteric ischemia is usually divided into four categories, based upon etiology. Arterial embolism is the most common type and represents 40% to 50% of all acute mesenteric ischemia cases. Emboli most commonly originate from a cardiac source and occlude the superior mesenteric artery (SMA). Acute mesenteric arterial thrombosis accounts for 25% to 30% of acute mesenteric ischemia. The proximal SMA is the most common site of thrombosis. Nonocclusive mesenteric ischemia represents approximately 20% to 30% of the acute mesenteric ischemia cases. This condition is usually a result of relative hypovolemia, low cardiac output, and splanchnic vaso-constriction. Mesenteric vein thrombosis is the least common cause of acute mesenteric ischemia, accounting for approximately 5% to 10% of the cases. These cases are often associated with a concomitant intra-abdominal process such as malignancy or inflammation, or with primary clotting disorders such as factor V Leiden mutation.