Introduction: Acute Mesenteric Ischaemia (AMI) is a surgical emergency, with high morbidity and mortality rates attributed to delayed diagnosis and treatment. International research has recognised this, and developed protocols to address barries to prompt management, intended to improve these outcomes. This has yet to be explored in an Australian setting. This study aims to explore factors associated with AMI diagnosis and management in an Australian tertiary centre from 2020 to 2025. Methods: A retrospective audit was completed of patients admitted from 2020 to 2025 under the general surgical unit of The Royal Melbourne Hospital, with a diagnosis of AMI. Data regarding patient demographics, AMI management, and mortality outcomes, were recorded. Results: 32 patients had a confirmed AMI diagnosis over 5 years (average 5.3 patients per year). The median age of patients was 72.5 years (IQR 15.5). 25.8% of patients were transferred from other centres (mainly rural or regional centres). Regarding patient characteristics, 62.5% of patients were male, with common comorbidities including hypercholesterolaemia (43.8%) and active smoking status (41.9%). On presentation, 91.3% had abdominal pain, 77.8% demonstrated lactatemia and 63.0% demonstrated acidosis. 93.7% of patients underwent operative management, 61.3% of which had concurrent vascular surgery input intra-operatively. 96.9% required an ICU admission, with a median total length of stay of 14 days (IQR 27.8). Mortality was 46.9%. Conclusion: AMI is a rare but often fatal surgical emergency. In recognition of this, international guidelines have been developed to address patient and management factors to reduce morbidity and mortality outcomes. Future research is required within an Australian context to understand these factors, and develop protocols intended to address barriers to prompt diagnosis and treatment of AMI.