This is a common enough event in the ICU that one might have expected something earlier - but, in all recorded history of the CICM exam (at least for which I have any previous papers) a serious discussion of ischaemic gut has only ever come up once, in Question 12 from the first paper of 2017. This SAQ asked for a detailed exploration of mesenteric ischaemia, specifically asking candidates to "outline the pathophysiology, diagnosis and treatment". What does an intensivist need to know about this for their final exams? Not much, if Oh's Manual is anything to go by. Mesenteric ischaemia comes up once as a quarter-page discussion in Jamie Cooper's chapter on lactic acidosis (p/160 of the 7th edition), where much is made of how difficult it is to diagnose, and how one must have a high index of suspicion. Nothing in the way of concrete recommendations or instructions is offered, which is characteristic of the Manual (and defies the definition of a manual).