A patient in the thirties, currently undergoing chemotherapy for metastatic osteosarcoma diagnosed 3 years earlier, was admitted with in the emergency department with abdominal pain. Laparoscopic surgery revealed severe infl ammation and an abscess. 18 cm of small intestine was removed because of intestinal necrosis. Histological examination showed several arterial tumour emboli, morphologically similar to the primary sarcoma. The patient died 1 year after successful surgery. Because of the improved survival of patients with osteosarcoma, acute mesenteric ischaemia should be considered in acute abdomen in these patients.