Acute mesenteric ischemia (AMI) is a condition that results from a sudden decline in blood flow through the mesenteric vessels that has a high morbidity and mortality. Non-occlusive AMI often presents in critically ill, hypotensive patients that suffer from decreased organ perfusion. Here we describe a case of non-occlusive acute mesenteric ischemia in the setting of transient hypotension precipitated by sildenafil. The patient required rapid fluid resuscitation in the emergency department. He did not require surgical intervention and was able to be discharged home with resolution of symptoms after a 7-day inpatient stay.