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Six cases of acute ischemic colitis (IC) were observed colonoscopically. All of them had acute onset with rectal bleeding and abdominal pain. Endoscopic picture was those of acute hemorrhagic segmental colitis. Any manifestation of acute colitis is possible in IC, so that endoscopy is sufficient in diagnocis of IC when acute segmental lesion is found in cases with typical clinical features. Five cases were presented: 1) typical IC, 2) segmental colitis with multiple discrete ulcers, 3) segmental colitis in which ulcers remained for more than months. 4) colitis in which the differentiation between IC and ulcerative colitis was difficult 5) Colitis in which the differentiation between IC and antibiotic-associated colitis was difficult. Angiographic demonstration of vascular abnormality is often difficult. Therefore IC is usually diagnosed without angiography. The clinical diagnosis is as follows. (1) Definite cases are equipped the following four conditions i) decrease in intestinal blood flow (e.g. elder person with cardiovascular con-ditions) ii) acute onset with rectal bleeding and abdominal pain iii) acute hemorrhagic segmental colitis iv) no history of antibiotics administration, no pathogenic bacilli shown in stool culture. (2) Probable cases lack one of above items (i-iv)