Acute mesenteric ischemia (AMI) is a curable disease if diagnosis and therapy are instituted before irreversible changes have occurred. AMI has been diagnosed with increasing frequency, during the last two decades, yet the mortality rate remains as high as 80% to 95%. Ninety-two patients with AMI were treated at Hadassah University Hospital between 1952 and 1987. Seventy-seven patients were treated surgically: 15 underwent only explorative laparotomy, and 62 underwent bowel resection or revascularization or both. The latter patients were divided into two groups: 17 patients treated surgically between 1952 and 1976, in whom bowel resection and primary anastomosis was the only surgical procedure carried out (group 1), and 45 patients treated in the last decade (group 2), in whom one or more of the following procedures were performed: bowel resection with primary anastomosis (n = 16), revascularization (n = 16), "second-look" (n = 18), and delayed anastomosis (n = 10). The overall mortality rate in 62 surgically treated patients was 40% (82% in group 1 and 24% in group 2) and 21% in 29 patients treated in a combined surgical approach. The reasons for improved results in group 2 patients are discussed, and an algorithm for surgical treatment of patients with AMI of different causes is proposed.