Background/Aims: Acute occlusion of the superior mesenteric artery (SMA) is rare and difficult to diagnose, the associated morbidity and mortality are still high. Here we review our experience in diagnosis and treatment of acute embolic occlusion of the SMA, determine factors for surgical complications and patient survival. Methodology: Thirty-seven patients with acute embolic occlusion of the SMA between 1993 and 2009 were retrospectively analyzed. Results: There were 23 (62.16%) men and 14 (37.84%) women, with a mean age of 59 years. Abdominal pain associated with nausea and vomiting was present in 32 (86.49%) patients. Twenty patients had atrial fibrillation. Emergency mesenteric arteriography was performed in 89.19% (33/37) patients. Fifteen patients were managed medically and 17 patients underwent surgical exploration. Of the 37 patients treated, 21 (56.75%) survived and were grouped as the survival group, 16 (43.24%) died and were grouped as the mortality group. In comparison with the survival group, patients in the mortality group had been delayed longer before definitive treatment and had higher white blood cell counts and proportion of neutral cells, shorter length of remaining bowel after surgery and higher incidence of renal insufficiency. Conclusions: Early diagnosis and intervention would improve the outcomes of patients with SMA. Identification of viable intestine and resection of the 1 necrotic bowel during surgery are critical in improving the survival rate.