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Ischaemic necrosis of the tongue. Necrosis of the tongue is a rare clinical finding. The rich vascularity of the tongue means necrosis is uncommon but it has been reported secondary to giant cell arthritis, radiotherapy and ischaemia. We report the case of a 61-year-old man admitted with an acute abdomen, who later developed gross swelling of the tongue, secondary to ischaemic necrosis, which necessitated tracheostomy placement. The ischaemia was managed conservatively with heparinisation and by allowing the ischaemic area to demarcate and slough off naturally.