Abstract This case-based resource represents a classic presentation of mesenteric ischemia. The patient has typical risk factors and physical exam findings, so his management requires a basic understanding of the pathophysiology of this condition. This resource was developed to help students and residents understand the presentation of this potentially fatal condition. Knowledge of the appropriate management of mesenteric ischemia is high yield for both board testing and real-life scenarios. For the purpose of board preparation, this case can be executed without many extra materials or props. Walking students through the case verbally helps them think aloud and many of the buzzwords associated with mesenteric ischemia can be easily inserted into the case at the appropriate times. After implementing the case at our institution and reviewing videos and comment cards submitted by participants, it was found that many thought this to be a challenging case. It seems that many people suspected the diagnosis but were unwilling to call the surgeon until a lactate level arrived or until they had radiographic evidence to justify their consult. Simulation has been demonstrated to be an effective tool for medical education, particularly in the emergency department. Having the opportunity to review and manage critically ill patients such as this one in a controlled environment is extremely helpful. Further, simulations such as this one increase the likelihood that actual patients with this condition will be readily recognized.