Acute mesenteric ischemia resulting from specific etiologies is a treatable vascular emergency. It requires a high index of suspicion and prompt, aggressive resuscitation and diagnostic maneuvers to determine the specific underlying cause. This will allow specific directed surgical revascularization, optimization of cardiac performance, or correction of a hypercoagulable state, all directed at maximizing the amount of functional bowel that is salvageable. These strategies are the cornerstones for a successful outcome in this life-threatening vascular catastrophe.