Ischemic colitis is a common form of intestinal ischemia incited by a low flow state resulting in mucosal ischemia. The elderly, critically ill, and those with risk factors for atherosclerotic vascular disease are disproportionally affected. The disease process is often transient and resolves with supportive care. However, prolonged periods of ischemia compounded by comorbid conditions that predispose patients to malperfusion can result in full-thickness injury and the need for surgery. Surgical management of ischemic colitis is associated with a high risk of morbidity, mortality, and permanent stoma formation. Chronic symptoms of ischemic colitis can occur in up to 20% of patients with recurrent symptoms after their initial episode. Given the risks associated with failure of nonoperative management, prompt recognition of symptoms of ischemic colitis, early initiation of treatment, and effective communication between medical and surgical teams are essential to avoid delay in appropriate treatment and to optimize patient outcomes.