Objective To explore the clinical features of acute mesenteric ischemia and CT angiography (CTA) findings. Methods The clinical data of 27 patients with acute mesenteric ischemia were retrospectively analyzed. The distribution of clinical features was analyzed, and the CTA imaging features were analyzed. Results All patients were accompanied by bloating or abdominal pain, and the remaining accompanying symptoms were mainly nausea, vomiting, poor appetite, peritoneal irritation sign, gastrointestinal bleeding, hematochezia and weakened or disappeared bowel sounds. The history mainly included the histories of abdominal surgery, hypertension diseases, atrial fibrillation and coronary heart disease, and laboratory test results were mainly plasma D-dimer, bilirubin, transaminase, lactate dehydrogenase, increased white blood cell count and reduced plasma hemoglobin. 3 patients died of treatment failure (11.11%). The direct signs of CTA mainly included mesenteric arteriovenous filling defects, wall thickening or roughening and a few visible mesenteric vessel wall calcification plaques or nodules. The indirect signs could observe the involved intestine, dilatation of intestine with or without gas liquid level, abdominal gas or effusion, annular thickening of intestine wall and abnormal enhancement of intestinal wall, a few visible pneumatosis intestinalis and portal venous gas. Conclusion The clinical features of acute mesenteric ischemia are not typical, but its CTA signs are intuitive and accurate, and are of great significance for early diagnosis and treatment of mesenteric ischemia.