Mesenteric ischemia is a difficult clinical diagnosis that requires a high index of clinical suspicion because the clinical and imaging features of intestinal ischemia and infarction overlap with many other intestinal disorders, and patients who have mesenteric ischemia often have coexisting diseases. Multidetector CT (MDCT) evaluation of the abdomen is the examination of choice when mesenteric ischemia is suspected because of its ability to provide two-dimensional multiplanar and three-dimensional display of the mesenteric vasculature and small intestine. This article reviews the clinical features, pathophysiology, and MDCT features of mesenteric ischemia.