Acute mesenteric ischemia: the diagnostic challenge and treatment options XIN Shi-jie, WANG Lei. Division of Vascular and Thyroid Surgery, Department of General Surgery, the First Hospital of China Medical University, Shenyang 110001, China Corresponding author: XIN Shi-jie, E-mail: xinshijie1963@yahoo.com.cn Abstract Acute mesenteric ischemia is a life-threatening emergency with multiple etiology, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, nonocclusive mesenteric ischemia, and other rare conditions. Massive bowel necrosis is the endpoint of pathological process, associated with a high mortality. Despite the improvement of diagnostic technique and medical condition, there are still many patients could not accept early diagnosis and prompt effective treatment. Strong clinical suspicion based on a better understanding of risk factor, pathology, clinical characteristic and treatment options will improve the prognosis.