An 88-year-old man had a sudden onset of severe and intense abdominal pain. I was on duty that day, and after initial history taking and physical examination, I confirmed that this was no ordinary abdominal pain! It was likely to be an acute superior mesenteric artery embolism. If not treated surgically in time, it could be life-threatening at any time! A subsequent 3D reconstructive CT (CTA) scan of the abdominal vasculature verified my diagnosis. What is superior mesenteric artery embolism? Superior mesenteric artery embolism (SMAE), similar to myocardial infarction, pulmonary embolism and cerebral thrombosis, is a blood clot blocking a blood vessel in a vital organ. SMAE is a rare disease with an annual incidence of about 8.6/100,000, but once it occurs, the condition is extremely dangerous, with a mortality rate of 70% to 100%. During surgery, the entire five to six meter long small intestine was found to be pale and cold due to ischemia, and part of it had turned black due to ischemic necrosis, and the root of the superior mesenteric artery was completely blocked by thrombus. The black thrombus in each branch was carefully removed with a Fogarty thrombectomy catheter, and with the restoration of blood flow, most of the intestine regained its pink color and normal temperature. However, because the local mesentery was completely ischemic and necrotic, about 1 meter of jejunum had to be removed. During the operation, we waited patiently for 1 hour for observation, and again judged the viability of the remaining small intestine and removed the necrotic part. Professor Li Yuanxin’s philosophy of treatment for mesenteric thrombosis is that the remaining seemingly intact small intestine can still become ischemic necrosis with thrombosis again after a few hours, and if the intestinal anastomosis is forced reluctantly, it will bring a fatal blow to the patient once an anastomotic fistula occurs. Therefore, the remaining intestinal tube was directly pulled out of the abdominal cavity for temporary fistula, which on the one hand avoided anastomotic fistula, and on the other hand facilitated the observation of the blood supply of the remaining intestinal tube after surgery, so that once ischemic necrosis occurred again, the patient could be operated again at any time. After close cooperation between the gastrointestinal surgery and vascular surgery teams, the patient’s surgery was successfully completed, and then the patient was actively anticoagulated in the intensive care unit to pass the dangerous period, and the patient recovered successfully. The remaining small intestine was red in color and showed no signs of ischemia, and the latest angiography results suggested that the entire superior mesenteric artery and its branches were open to blood flow. Conclusion: Superior mesenteric artery embolism has low morbidity, high mortality, and rapid disease progression, requiring physicians to have rich clinical experience in diagnosis and treatment. Emergency essential enhanced CT for angiography (CTA) is the key to confirm the diagnosis, and timely multidisciplinary team treatment, standardized and rationalized surgical management, post-surgical correction of the primary disease, and active anticoagulation are the keys to diagnosis and treatment of this disease.