Adhesive small bowel obstruction (aSBO) remains one of the most common causes of surgical admission and morbidity. With advancements in imaging and the advent of water-soluble contrast, management has become increasingly non-operative. Although this is successful in a majority of patients, patients who fail this trial without operation may face worse outcomes. Delays to surgical intervention are associated with increased rates of bowel ischemia, resection, infectious complications, and mortality. Optimal management therefore depends on early risk stratification, disciplined non-operative trials, and timely escalation to operation when indicated. This review summarizes contemporary evidence regarding pathogenesis, pathophysiology, epidemiology, diagnostic evaluation, management, and outcomes of aSBO, with a focus on practical decision-making. The evaluation of each patient's obstruction consists of subjective clinical findings in combination with objective data including labs and imaging. CT with intravenous contrast remains a cornerstone of diagnosis, allowing identification of obstruction severity and features concerning for ischemic physiology that mandates immediate operative exploration. In the absence of these findings, a structured trial of non-operative management may be pursued, including nasogastric decompression, intravenous resuscitation, electrolyte correction, and inpatient admission with close oversight from a surgical team. Water-soluble contrast studies serve as both a prognostic and therapeutic adjunct, as failure of contrast to reach the colon within 24 hours is strongly predictive of unsuccessful non-operative management. Operative management should be undertaken promptly in patients with clinical deterioration, imaging evidence of ischemia, or failure of non-operative therapy. Although open laparotomy remains the standard approach, laparoscopy may be considered in carefully selected patients in experienced hands. Across management strategies, early surgical ownership and avoidance of prolonged non-operative trials in high-risk patients are critical to optimizing outcomes. aSBO is best managed through structured algorithms that prioritize early diagnosis, time-sensitive reassessment, and decisive operative intervention when indicated.

The present study investigated the protective effects of lithium borate (LTB) against lung injury secondary to intestinal ischemia/reperfusion (I/R) in rats. Twenty-four male Wistar rats were allocated to four groups: control, I/R, LTB, and I/R+LTB. Intestinal ischemia was induced by superior mesenteric artery occlusion for 45 min, followed by 3 h of reperfusion. The LTB group received 15 mg/kg oral LTB for 5 days; the I/R+LTB group underwent I/R following the same LTB protocol. At the end of the experiment, lung tissue samples were taken from the rats and subjected to biochemical, histopathological, and immunohistochemical analyses. Biochemical results showed an increase in superoxide dismutase (SOD) activity, a reduction in catalase (CAT) and glutathione peroxidase (GSH-Px) activities, a reduction in glutathione (GSH) levels, and an increase in malondialdehyde (MDA) levels in the I/R group. LTB treatment reduced oxidative stress by bringing these parameters to values close to those of the control group. Histopathological examination revealed edema, hemorrhage, thickening of the interalveolar septa, and marked inflammatory cell infiltration in the I/R group, which were substantially attenuated in the I/R+LTB group. Immunohistochemical analyses showed increased Bcl-2 and caspase-3 expression in the I/R group, whereas LTB treatment was associated with reduced caspase-3 expression and modulation of Bcl-2 immunoreactivity. In conclusion, LTB attenuates oxidative stress, reduces histopathological lung damage, and suppresses apoptosis following intestinal I/R injury, suggesting its potential protective role against remote lung injury.

While infection is a recognized complication of congenital urachal cysts, progression to an inflammatory phlegmon causing bowel ischemia is an exceptionally rare and life-threatening event in the pediatric population. We report the case of a 14-year-old male with a 7-year history of an infraumbilical mass who presented with an acute abdomen. Contrast-enhanced computed tomography revealed a 7.1 cm urachal phlegmon with a central necrotic core and dense adherence to the adjacent ileum. Exploratory laparotomy confirmed irreversible segmental small bowel ischemia, necessitating en-bloc excision of the urachal remnant and the affected 12 cm ileal segment with a primary anastomosis. Histopathology confirmed a benign infected cyst with associated transmural bowel necrosis. This case highlights that long-standing urachal anomalies can evolve into aggressive inflammatory masses capable of precipitating visceral compromise. It underscores the importance of a high index of suspicion for rare complications and supports the consideration of definitive surgical excision for symptomatic remnants to mitigate the risk of severe morbidity.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, though it rarely presents with complications in adulthood. Axial torsion leading to gangrene, especially due to a mesodiverticular band, is an uncommon presentation and may pose a diagnostic challenge. We report a case of a 58-year-old female who presented with acute intestinal obstruction. Diagnostic laparoscopy revealed a gangrenous MD caused by axial rotation around a mesodiverticular band, without involvement of the adjacent ileum. Laparoscopic diverticulectomy was successfully performed. Isolated torsion of the MD is rare, particularly in adults. A mesodiverticular band can predispose to isolated volvulus, ischaemia and gangrene. Early surgical intervention is essential to prevent morbidity, and complicated MD in adults is often misdiagnosed. A high index of suspicion should be maintained in cases of intestinal obstruction with atypical features. This case highlights the importance of early laparoscopic evaluation in adults presenting with unexplained obstruction.

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke subtype with high morbidity and mortality, significantly contributed to by secondary brain injuries such as early brain injury and delayed cerebral ischemia. Despite advances in acute management, effective neuroprotective strategies remain an unmet need. The microbiota-gut-brain axis (MGBA), a pivotal bidirectional communication network, has recently emerged as a critical modulator of pathophysiology in acute brain injuries. However, its precise role and therapeutic potential in aSAH are not systematically defined. This review synthesizes clinical and preclinical evidence to move beyond correlation and delineate the spatiotemporal dynamics and the mechanisms that may underlie of MGBA dysregulation post-aSAH. We conceptualize a self-amplifying "brain-gut-brain" vicious cycle: the initial brain injury may disrupt intestinal barrier integrity and microbiota ecology via neuroendocrine and inflammatory pathways; in turn, gut-derived signals (e.g., altered microbial metabolites, endotoxin translocation) may propagate systemic inflammation and exacerbate neuroinflammation, blood-brain barrier disruption, and cerebral ischemia. We dissect this cycle by detailing the key molecular bridges (tryptophan metabolites, short-chain fatty acids, bile acids), signaling pathways (e.g., TLR4/NF-κB, NLRP3 inflammasome), and central effectors involved. Furthermore, we provide a critical, stratified evaluation of MGBA-targeting therapeutic strategies - including probiotics, prebiotics, fecal microbiota transplantation, and metabolite supplementation - assessing their mechanistic rationale, level of evidence, and translational challenges. Finally, we outline future directions emphasizing the need for defining therapeutic windows, establishing causal proof, and integrating MGBA modulation into multimodal neurocritical care. Harnessing the MGBA presents a novel and promising paradigm for developing adjunctive neuroprotective therapies to improve outcomes after aSAH.

Acute pancreatitis is defined as acute inflammation of the pancreas. The diagnosis of the condition is made on the basis of three key factors: epigastric pain, elevated enzymes levels and abnormal imagine tests. The classification of such cases is determined by the presence or absence of organ failure and the stage of (peri)pancreatic necrosis. Cases with persistent organ failure should be referred to the Intensive Care Unit. Management strategies emphasize supportive measures, adequate hydration, effective pain management, and the early initiation of nutrition. The use of antibiotics as a prophylactic measure is to be avoided. Surgery is indicated in cases of hollow organ perforation, intestinal ischemia, or failure of medical treatment in compartment syndrome. In general, the management of infected necrosis should be conservative or minimally invasive. However, should the condition develop before encapsulation and be associated with organ failure, noninvasive drainage is indicated. If such management proves ineffective, open necrosectomy should be considered.

A 77-year-old man presented to the Emergency Department with abdominal pain radiating to his back and two episodes of food-related vomiting. Physical examination revealed no signs of acute abdomen, and blood tests showed marked leukocytosis and elevated C-reactive protein (CRP). An abdominal X-ray and CT scan performed five hours later revealed no acute pathology. However, the patient's condition worsened over the next 32 h, and he died without a clinical diagnosis. A judicial autopsy revealed an ileo-jejunal volvulus with necrotic bowel, peritoneal effusion, but no signs of perforation. Histopathological examination confirmed ischemia in the affected intestinal segment. The forensic review of the X-ray and CT scans revealed signs of intestinal obstruction and small bowel volvulus that had not been detected during the hospitalization. The comprehensive analysis of clinical, radiological, autopsy, and histopathological data revealed that septic shock from peritonitis, secondary to volvulus-induced small bowel ischemia, was the cause of death. This case provides an opportunity, within the context of medico-legal liability assessment, to reflect on the influence of cognitive biases that may have contributed to the misdiagnosis. Furthermore, it highlights the role of legal medicine in supporting the systematic investigation of adverse events and in guiding interventions within hospital risk management processes.

Background and Clinical Significance: Polycythemia vera (PV) is a myeloproliferative neoplasm associated with a markedly increased risk of arterial and venous thrombosis. Superior mesenteric artery (SMA) thrombosis is an exceptionally rare but potentially fatal complication. Case Presentation: We report the case of a 25-year-old man with previously diagnosed, JAK2-negative PV who presented with acute abdominal pain, nausea, vomiting, abdominal distension, and absence of stool and flatus, consistent with clinical features of intestinal obstruction. Laboratory testing revealed marked leukocytosis, elevated inflammatory markers, and subtherapeutic anticoagulation (INR 1.2) despite ongoing oral therapy. Multislice computed tomography demonstrated occlusion of the SMA with developed collateral circulation and features of small-bowel ischemia. Due to progression to an acute abdomen, emergency laparotomy was performed, revealing jejunal perforation with preserved viability of the remaining bowel. Primary closure was carried out, followed by peritoneal lavage and drainage. The postoperative course was uneventful. After correction of anticoagulation and therapeutic INR monitoring, no recurrent thrombotic events were observed during follow-up. Conclusions: This case underscores the importance of strict anticoagulation control, early imaging, and prompt surgical intervention in patients with PV, even in young individuals and in atypical vascular territories.

Internal herniation is a recognised complication following Roux-en-Y gastric bypass (RYGB) and may lead to life-threatening conditions. The diagnosis of abdominal emergencies in pregnant patients who have undergone bariatric surgery is particularly challenging due to physiological and anatomical changes.

This paper reports a special case in which retrograde intussusception of the efferent loop through the gastrojejunostomy into the gastric remnant led to closed-loop intestinal obstruction and small bowel ischemia. The patient was a 69-year-old male with a history of subtotal gastrectomy, who was admitted for acute abdominal pain. Initial computed tomography (CT) findings were inconclusive, while contrast-enhanced CT suggested the possibility of intussusception. Emergency surgery confirmed the diagnosis, and the patient underwent gastrotomy with reduction, followed by partial small bowel resection and anastomosis. The postoperative recovery was uneventful. This case highlights the rare location, diagnostic challenges, and the importance of multidisciplinary management in postgastrectomy internal hernia/intussusception. Based on a literature review, we provide an in-depth discussion of its pathogenesis, imaging characteristics, and surgical management strategies.

Congenital intestinal malrotation is a rare developmental anomaly that typically presents during childhood but may remain undiagnosed until adulthood, when symptoms can arise abruptly due to volvulus or intestinal ischemia. We report the case of a 33-year-old woman, previously healthy, who presented with acute abdominal pain, abdominal distension, and peritoneal signs. Laboratory tests revealed mild neutrophilic leukocytosis. Abdominal computed tomography with oral Gastrografin demonstrated marked gastric distension and mesenteric swirling, initially suggestive of intestinal volvulus. Urgent surgical exploration revealed congenital intestinal malrotation with abnormal positioning of bowel loops and a volvulated ileal segment showing vascular congestion and early ischemic changes. Derotation and careful assessment of bowel viability were performed; due to persistent ischemic changes, resection of the compromised ileal segment with primary mechanical anastomosis was required. Postoperative recovery was uneventful. This case highlights the diagnostic challenges of intestinal malrotation in adults, where clinical presentation is often nonspecific and radiologic findings may be misleading. Early surgical intervention remains essential to prevent irreversible ischemic injury and bowel necrosis.

Vascular intestinal disorders (VID), including acute mesenteric ischemia and related intestinal vascular insufficiency syndromes, are rare but highly lethal causes of abdominal emergency mortality. National trends in VID mortality, and whether improvements have been equitable across demographic and geographic groups, have not been characterized through 2023. We conducted a nationwide ecological analysis of VID mortality in the United States from 1999 to 2023 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. We included adults aged 25 years or older when VID was listed as the underlying cause of death. For each year, we extracted the national death count and the age-adjusted mortality rate (per 1,00,000 population) and evaluated temporal change. From 1999 to 2023, 2,03,870 VID deaths occurred. Annual deaths declined from 8711 in 1999 to 7676 in 2023. Over the same period, the national age-adjusted mortality rate decreased from 4.93 to 2.75/1,00,000, corresponding to an average annual percent change of -2.41%. Deaths were concentrated in older adults: individuals aged 75 to 84 years accounted for 66,509 deaths (32.6% of all VID deaths), and those aged 85 years or older accounted for 59,009 deaths (28.9%). Females accounted for 1,30,125 cumulative VID deaths and males for 73,745. Nonmetropolitan counties and Southern regions carried a disproportionate share of deaths. Although VID mortality declined on an age adjusted basis, the absolute burden remains greatest in the oldest adults and in structurally disadvantaged settings, indicating persistent geographic and demographic inequity during and beyond the COVID-19 era.