Chronic mesenteric ischemia (CMI) is a rare condition and it could be mis-diagnosed becouse lack of specific signs. Patients with chronic mesenteric ischemia (CMI) typically present with a history of the chronic intermittent abdominal pain, fear of eating and weight loss. The etiology of chronic mesenteric ischemia is multifactorial which includes atherosclerosis risk factors such as diabetes, hypertension, hyperlipidemia, smoking and obesity. Herein, we present a case whose only risk factor was smoking and presented with subacute abdominal pain. A 74-year-old woman was admitted to outpatient clinic with continuous abdominal pain, vomiting and diarrhea for 2 weeks. She had no other symptoms and chronic diseases. She is an active smoker for 58 pacs/year. Her physical examination revealed that diffuse abdominal pain without peritoneal signs. Laboratory results demonstrated an inflammatory condition however, abdominal ultrasound and endoscopic examination were in normal limits. Contrast enhanced abdominal CT revealed acute exacerbation of CMI. The patients treated with endovascular stent implantation and all symptoms were resolved. Chronic mesenteric ischemia could seen with atypical presentations, solely due to smoking without multiple risk factors in older patients. Therefore, it should be remembered that the diseases may be encountered in atypical presentations in older patients. Moreover, smoking habits should be questioned and patients should be reminded about smoking cessation.