Acute mesenteric ischemia (AMI) is a life-threatening condition caused by insufficient blood supply to the intestines. It is associated with conditions such as arterial thromboembolism, ischemic colitis, and nonocclusive mesenteric ischemia (NOMI). AMI presents diagnostic challenges, particularly in elderly patients with multiple comorbidities, leading to high mortality rates. This study aimed to identify predictive factors for poor outcomes in AMI patients undergoing surgical resection, focusing on clinical variables, laboratory findings, and risk factors for mortality. Methods: A retrospective study was conducted at PSP Medical College & Hospitals, Chennai, and Indira Medical College & Hospitals, Pandur, from October to December 2024. Thirty-nine AMI patients were analyzed based on demographic data, clinical presentation, hemodynamics, laboratory parameters, and surgical findings. Statistical analysis was performed using SAS software, employing chi-square tests, univariate analysis, and logistic regression to identify independent predictors of mortality. Results: The study cohort had a mean age of 65.26 years, with a male predominance. The most common comorbidities were hypertension (69.2%), diabetes (35.9%), and arrhythmias (38%), though none showed a significant association with mortality. Shock and acute renal failure (ARF) were identified as strong predictors of poor outcomes, with 64.7% of non-survivors presenting with ARF (p = 0.026). Elevated AST and ALT levels were significantly correlated with higher mortality rates (p = 0.001). Multivariate analysis identified elevated AST and ALT as independent predictors of poor prognosis. Among surgical cases, 82% underwent bowel resection, while 17.9% underwent diagnostic laparotomy. The overall mortality rate was 43.9%, with non-survivors exhibiting prolonged ICU stays and severe hemodynamic instability. Conclusion: Early recognition of AMI and prompt surgical intervention are crucial for survival. Elevated AST and ALT levels, ARF, and hemodynamic instability were identified as significant predictors of poor outcomes. While liver dysfunction and intestinal ischemia are interrelated, further studies are needed to establish a direct link between portal vein thrombosis and AMI prognosis. Early diagnosis and aggressive management strategies remain critical in reducing AMI-associated mortality