Advances in equine gastrointestinal surgery have signifi cantly improved the management and outlook for this condition; however, further progress is still needed, as intestinal ischaemia continues to be associated with a relatively high mortality rate. Therefore, this work aimed to contribute to the evidence-based diagnosis and treatment of intestinal ischaemia in horses. It provides novel insights into the mechanisms of injury and the degree of ischaemia in naturally occurring lesions. Additionally, intraoperative assessment of intestinal viability is investigated, including the use of real-time ancillary diagnostics and optimised biopsy techniques. Concerning adjunctive treatments, various pharmacological agents have been assessed for their potential in managing intestinal ischaemia. By exploring new approaches in pathophysiology, diagnostics, and therapies, this research addresses current knowledge gaps in equine colic, paving the way for better outcomes in horses affected by this condition.