Between 1980 and 2002 a total of 187 patients (105 women, 82 men) with a mean age of 71.5 years underwent surgery for acute mesenteric infarction (AMI) in our department. Arterial occlusion was found in 140 patients, splanchnic vein thrombosis in 22, and nonocclusive AMI in 25. We performed bowel resection in 61 patients, vascular surgery in 32, a combination of the two in 15, and an exploratory laparotomy in 79. The mortality rate was 70.6% (73.9% in patients >70 years and 65.2% in those <70). AMI is still a disease with a consistently high mortality rate (60-80%). Multivariate prognostic factors include the time until surgery and a markedly elevated white blood cell count and serum lactate level. Mortality and secondary disease rates are higher in the elderly, and the fact that they have to wait much longer for an operation than younger patients may be a factor. If surgery is performed early, the survival rate increases regardless of age. The most important prognostic factor and the only one that can be influenced by the surgeon remains the time interval between the onset of symptoms and surgery, Therefore diagnostic and therapeutic intervention should be performed as early as possible in patients with suspected AMI.