Objective：To explore the early diagnosis and treatment of acute superior mesenteric arterial embolism (ASMAE).
Methods：The clinical data of 25 patients with acute superior mesenteric arterial embolism were retrospectively analyed.
Results：All 25(100%) patients had severe abdominal pain with abdominal signs, 21(84%) patients had  history of valvular heart disease or atrial fibrillation, and 17(68%) patients had hematochezia. All the cases were misdiagnosed preoperatively, including 11 patients were misdiagnosed as abdominal pain of unknown causes, 3 patients as acute pancreatitis, 3 patients as acute gastroenteritis, 2 patients as necrotizing enteritis. 1 patient as acute appenditis, 1 patient  as acute myocardial infarction,and 1 patient  as acute cholecystitis; but 3 patients were  preoperatively  suspected to have impairment of mesenteric blood flow. All of the  25 patients underwent necrotic bowel resection, 6 patients died,  and 7 patients abandoned treatment because of serious complications  such as short bowel syndrome etc. Mortality rate was 51%（13/25）.
Conclusions：Early diagnosis of patients with acute superior mesenteric arterial embolism is difficult; the main cause of misdiagnosis is lack of recognition of its clinical signs. Fully grasping the characteristics of patients with early stage disease and effective early intervention are the fundamental measures for reducing mortality.