Objective To investigate the ultrasound image features of ischemic bowel disease(IBD) in the elderly and evaluate their significance in clinical practice. Methods Transabdominal ultrasonography was performed in 23 elderly out- and in-patients who were admitted to our hospital due to acute abdominal pain and hematochezia from October 2007 to October 2012. The ultrasound images were analyzed along with clinical manifestations and endoscopic findings. Results Diagnosis of IBD was confirmed in all cases by endoscopy and clinical manifestations. While, transabdominal ultrasonography established the diagnosis with an accuracy of 82.6% (19/23). Ischemic lesions were identified in the left side of colon in 12 patients (52.2%), on the descending colon in 5 patients (21.7%), on the sigmoid colon in 3 patients (13.0%), and on the splenic flexure colon in 3 patients (13.0%). The thickness of colon wall was increased to 0.61 to 1.91cm. The length of involvement part ranged form 10 to 19cm. The involved colon was symmetrically and circumferentially thickened, and the normal structure of colon wall became unclear or disappeared, as irregular hypoechoic areas in the ultrasound images. The involved colon became slightly narrow in cavity, resulting in slowed or disappeared peristalsis. There was a little fluid sonolucent area in 8 patients, and swelled lymph nodes (＞0.6cm) in the retroperitoneal area in 9 patients. There were 12 patients without obvious blood flow signals, and 11 patients with only sparsely dotty or short strip-like blood flow signals. Conclusion Transabdominal ultrasonography is beneficial to the early diagnosis of IBD. It clarifies the nature, location, and area of the lesions when combined with endoscopy, and has instructive value for clinical treatment.