The results of treatment of 24 patients with acute mesenteric obstruction analyzed. The intervention performed on the superior mesenteric artery (SMA) or the superior mesenteric vein (SMV) in order to restore blood flow. The age of patients is from 65 to 89 years. 6 patients diagnosed on the basis of clinical data alone, 16 – CT scans with bolus enhancement, and 2 – angiography of the aorta and its branches.
Operative interventions for acute abdominal ischemia must necessarily include revision of the superior mesenteric artery. The following sequence of actions suggested: 1) resection of the necrotic bowel; 2) revision of the superior mesenteric artery with an attempt to eliminate occlusion; 3) assessment of the viability of the remaining part of the bowel, additional resection of sites whose viability is questionable; 4) in the presence of conditions - the imposition of a primary anastomosis. This algorithm allowed maximally keep the intestine in case of its ischemia and avoided imposing high enterostoma, which are extremely unfavorable for patients.
In the case of venous gangrene of the intestine, thrombectomy from the superior mesenteric vein may performed through its brunches, revealed during resection of the necrotic part of the intestine. It allowed to reduce the volume of resection of the small intestine and completed the operation with a primary entero-enteroanastomosis.

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