Fourteen patients were treated for ischemia limited to the colon. In seven the cause was atherosclerosis or other vascular disease, and in seven it was shock secondary to hypovalemia, sepsis, or trauma. The natural history of the local ischemic process progressed from a reversible mucosal necrosis manifested on x-ray examination by thumb printing and stricture formation to full thickness colon infarction usually demonstrated on x-ray film by dilatation of the colon. Patients with full thickness necrosis require bowel resection in the acute stage. In our experience the mortality for this group was 90%. Patients with mucosal necrosis only can be cautiously supported and followed up with contrast x-ray examination, which will usually delineate the severity of the necrotic process.