Acute mesenteric ischaemia is an emergent situation that is difficult to diagnose. If untreated ischeamia will cause bowel infarction and necrosis leading to secondary inflammatory changes causing sepsis and patient’s death. Early diagnosis and timely surgical intervention are the cornerstones of treatment, as irreversible bowel damage occur within 6 hours of complete vascular occlusion. For a selected group of patients with a short history of illness (without clinical signs of peritonitis), endovascular treatment is applicable. In the case of peritonitis, open surgery is still the gold standard. Despite new treatment options, the mortality rates for acute mesenteric ischaemia remain high. Early diagnosis and effective co-operation between emergency department`s doctors, radiologists, surgeons and anesthesiologists is necessary.