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Acute ischemic proctitis is a rare condition usually resulting from severe vascular disease or an acute vascular occlusion. The diagnosis is made on endoscopy, and mortality rates approach 20–40%. Many patients will require a proctectomy as the definitive treatment, especially for gangrenous proctitis. We describe an unusual presentation of acute ischemic proctitis in a patient without preexisting vascular disease or other precipitants. Furthermore, our patient recovered entirely with conservative management and intravenous antibiotics alone. We review the existing literature on ischemic proctitis and highlight the need for future research to better diagnose and manage this rare condition.