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This paper summarizes the epidemiology and diagnostic work-up of acute bowel ischaemia (ABI). Different etiologies are described: Arterial and venous, occlusive and non-occlusive hypoperfusion syndromes. All conditions, in particular embolus to the superior mesenteric artery, are more prevalent in older age-groups, explaining why the incidence is increasing over time, a result of demographic change. D-dimer is a readily available biomarker at most emergency wards working excellent as an exclusion test. A specific biomarker for intestinal ischaemia is not yet available. A break-through in diagnosing ABI is modern multi-detector CT-scan (MDCT), explaining why more patients are identified prior to irreversible bowel gangrene, and revascularized. It is important that the surgeon or physician communicates the clinical suspicion of ABI to the radiologist. An important part of the decision-making is if the MDCT should be performed in a patient with an elevated creatinin level, a common finding due to vomiting and hypovolaemia.

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