Background <p>Acute mesenteric ischemia (AMI) is a life-threatening condition requiring prompt diagnosis. Late detection significantly increases morbidity and mortality. This systematic review and meta-analysis assessed the diagnostic accuracy of d-dimer and lactate as biomarkers for AMI.</p> Methods <p>A comprehensive literature search across multiple databases (Cochrane, ScienceDirect, PubMed, Google Scholar, Scopus) followed PRISMA guidelines. Studies evaluating the diagnostic performance of d-dimer and/or lactate in suspected AMI cases were included. Data extraction and quality assessment were independently performed by two reviewers. Meta-analysis was conducted using a random-effects model to calculate pooled sensitivity, specificity, and the area under the curve (AUC) of the summary receiver operating characteristic curve (SROC). Methodological quality was assessed using QUADAS.</p> Results <p>A total of 20 studies were included. Significant variability was noted in biomarker cut-offs, sampling timing, and measurement methods. The pooled sensitivity and specificity of d-dimer for AMI were 0.85 (95% CI 0.80–0.89) and 0.50 (95% CI 0.46–0.54), respectively. The AUC was 0.85, indicating high diagnostic accuracy. For lactate, pooled sensitivity and specificity were 0.67 (95% CI 0.57–0.76) and 0.67 (95% CI 0.58–0.75), with an AUC of 0.79, also suggesting good diagnostic accuracy.</p> Conclusion <p>D-dimer and lactate demonstrate potential as early diagnostic biomarkers for AMI in emergency settings; however, their use should be adjunctive to imaging and clinical evaluation for optimal patient outcomes. Further large-scale studies are needed to validate these findings and refine diagnostic protocols.</p>