Introduction: Regardless the progress achieved in diagnosis and surgical treatment of acute mesenteric ischemia (AMI) mortality rate is still elevated in these patients. AMI is still a catastrophe with the most complex and controversial issues in abdominal surgery. Material and methods: Authors present herein the results of surgical management of 53 consecutive cases of AMI. Median age was 68.4±1.8 years (95% CI:64.77-72.06). AMI was confirmed by thrombogenesis and thrombolysis markers, serum lactate, ischemia modified albumin, 3DCT angiography and laparoscopy. The patients were treated according to Damage Control Surgery (DCS) principles: compromised bowel resection without anastomosis, laparostomy, including VAC-system, ICU patients‘ stabilization and consequent surgery for GI tract reconstruction. The average length of resected bowel at primary surgery was 220.1±20.75 cm (95% CI:178.2-262.1). Segments of ischemic bowel were: jejunum (n = 4), ileum (n = 11), jejunum ? ileum (n = 14), ileum ? right hemicolon (n = 2), jejunum ? ileum ? right hemicolon (n = 14), total bowel necrosis - n = 8. The median time from primary surgery till gastrointestinal tract reconstruction was 44.7 ±2.8 hours (95% CI:39.15-50.33). Results: Postoperative mortality rate was 60.37%. Conclusion: Damage Control Surgery in case of acute mesenteric ischemia significantly reduces postoperative mortality rate compared with the conventional approach. References: . Disclosure: No significant relationships.