Acute mesenteric ischemia (AMI) is a life-threatening condition caused by insufficient blood supply to the intestines, often presenting with vague clinical symptoms that complicate early diagnosis. This retrospective study, conducted at Gouri Devi Institute of Medical Sciences & Hospital from 2015 to 2019, aimed to identify predictors of poor outcomes in AMI patients undergoing surgical intervention. The study excluded mechanical bowel ischemia and analyzed clinical variables, including demographic data, comorbidities, laboratory parameters, and hemodynamic status. Among the 39 patients evaluated, common comorbidities included hypertension (69.2%), diabetes (35.9%), and arrhythmias (38%). Acute kidney injury (AKI), shock, and elevated liver enzymes (AST and ALT) were significantly associated with higher mortality. Logistic regression analysis identified elevated AST (OR 7.022, p=0.036) and ALT (OR 12.41, p=0.024) as independent predictors of poor prognosis. Surgical outcomes revealed that 82% underwent bowel resection, with a mortality rate of 43.9%. This study highlights the importance of early diagnosis and intervention in AMI, with elevated liver enzymes serving as key markers for severity and prognosis. The findings underscore the complex interplay between intestinal ischemia, systemic inflammation, and organ dysfunction. Future research should explore the role of liver dysfunction in AMI pathogenesis and its association with thrombosis. Timely recognition of risk factors and aggressive management are essential to improving patient outcomes.