To investigate the factors influencing small intestinal ischemia in elderly patients with incarcerated hernia. The clinical data of 105 elderly patients admitted for surgical procedures of incarcerated hernia at Department of General Surgery, Huadong Hospital between January 2014 and December 2021 were retrospectively analyzed. There were 60 males and 45 females, aged (86.1±4.3) years (range: 80 to 96 years). They were divided into normal group (=55) and ischemic group (=50) according to intraoperative intestinal canal condition. The test, test and Fisher’s exact probability method were used for the univariate analysis of the factors that influence intestinal ischemia in patients, and Logistic regression was used for multifactorial analysis. In all patients, 18 patients (17.1%) had irreversible intestinal ischemia with bowel resection. Six patients died within 30 days, 3 cases from severe abdominal infection, 2 cases from postoperative exacerbation of underlying cardiac disease, and 1 case from respiratory failure due to severe pulmonary infection. The results of the univariate analysis showed that there were differences in gender, history of intussusception, duration of previous hernia, white blood cell count, neutrophil percentage, C-reactive protein, type of incarcerated hernia, and preoperative intestinal obstruction between the two groups (all <0.05). The Logistic regression results showed that the short time to the previous hernia (=0.892, 95% 0.872 to 0.962, =0.003), high C-reactive protein (=1.022, 95% 1.007 to 1.037, =0.003), non-indirect incarcerated hernia (=10.571, 95% 3.711 to 30.114, <0.01 and preoperative intestinal obstruction (=6.438, 95% 1.762 to 23.522, =0.005) were independent risk factors for the development of intestinal ischemia in elderly patients with incarcerated hernia. The short duration of the previous hernia, the high values of C-reactive proteins, the non-indirect incarcerated hernia, and the preoperative bowel obstruction are influencing factors for bowel ischemia in elderly patients with incarcerated hernia. A timely operation is necessary to reduce the incidence of intestinal necrosis and improve the prognosis.