Acute mesenteric ischemia (AMI) presents variably based on etiology—arterial embolism (often from atrial fibrillation), arterial thrombosis (due to atherosclerosis), mesenteric venous thrombosis (linked to hypercoagulability), or nonocclusive ischemia (from low-flow states in critically ill patients). Diagnosis is confirmed with biphasic multidetector CT angiography. Early recognition is essential, as delayed diagnosis worsens outcomes. Treatment varies from anticoagulation to surgery or endovascular intervention. Resuscitation, rapid diagnosis, and revascularization (“3 R”s) are key. AMI should not be ruled out with normal laboratories if the patient has risk factors for the disease. Multidisciplinary collaboration is crucial to improve outcomes and preserve bowel viability.