Myocardial ischemia-reperfusion injury (MIRI) remains a critical clinical condition with limited preventive and therapeutic strategies, underscoring the need for novel interventions. The gut-heart axis and exosomal crosstalk hold therapeutic promise for cardioprotection, yet the fundamental question of which specific gut cells release the beneficial exosomes is unanswered. This study aimed to elucidate whether ginseng polysaccharides WGPA exert remote cardiac protection by regulating intestinal immune homeostasis, specifically through promoting the release of exosomes from regulatory T cells (Tregs). Using integrated in vivo and in vitro models, we evaluated the protective effects of WGPA against MIRI. The results demonstrated that WGPA pretreatment significantly attenuated myocardial injury and improved cardiac function. Mechanistically, WGPA selectively activated intestinal Tregs and enhanced the release of HSP70-enriched exosomes. These exosomes entered systemic circulation and were delivered to the heart, where surface HSP70 interacted with TLR4 on cardiomyocytes, activating downstream protective signaling pathways and ultimately suppressing cardiomyocyte death and inflammatory responses. Our study reveals for the first time a complete mechanism by which medicinal plant polysaccharides confer cross-organ cardioprotection via the "intestinal Tregs-exosome-heart" axis, providing a novel theoretical basis and a potential intervention strategy for the prevention and treatment of MIRI.

Senna laxative, one of the major stimulant laxatives, has received less attention regarding its potential risk of intestinal ischemia in the elderly population. An 87-year-old female with a past medical history of chronic constipation developed abdominal pain and fever after oral ingestion of senna laxative for constipation and was subsequently diagnosed with ischemic bowel disease upon hospitalization. Symptomatic and supportive treatment, such as antibiotics, acid inhibition and stomach protection, fluid replenishment, and intravenous nutrition, was given. After treatment, the patient's condition stabilized, her symptoms improved, and she was allowed to leave the hospital. This case highlights that the use of senna laxative in elderly patients may lead to severe ischemic intestinal disease. Clinicians should be vigilant about the adverse reactions of senna laxative in elderly patients.

Endovascular aneurysm repair (EVAR) is a treatment method that has become increasingly popular for abdominal aortic aneurysms (AAA) due to its ease of application, reduced hospital stay, and its suitability as an alternative for patients who cannot tolerate open surgery. Although the early outcomes of EVAR are better than those of open surgery, complications such as endoleak, migration, thrombosis or kinking of the endograft limbs, graft infection, and secondary rupture may occur. In this study, we present a patient who underwent EVAR at another institution approximately 10 years earlier and was admitted to our clinic with complaints of deterioration in general condition, fever, and melena. Laboratory examination of 73-year-old man revealed a white blood cell (WBC) count of 17,100, hemoglobin level of 9.5 g/dL, and C-reactive protein (CRP) level of 261 g/L. Computed tomography (CT) revealed thrombosis within the EVAR graft, free air surrounding the graft, fractures in the graft stents, and displacement of the right limb beyond the aorta at the level of the iliac bifurcation. The endograft was observed to have migrated toward the duodenum and formed a fistula. The pa-tient, who presented with sepsis, underwent emergency surgery. Initially, a left axillofemoral bypass was performed to relieve ischemia in the left leg. Subsequently, a laparotomy was performed with the joint participation of the general surgery and cardiovascular surgery departments. Intra-abdominal fecal contamination and rupture of the sigmoid colon were observed. The abdomen was lavaged, the sigmoid colon and rectum were excised, and a colostomy was created. An aortotomy was then performed, and the main body of the graft and its left limb were removed. The duodenum was opened, and the fistulized right limb of the endograft was also removed. No additional vascular intervention was required due to abdominal contamination, adequate collateral circulation in the right leg, likely due to the chronic nature of the process, and the absence of ischemia. The aorta was ligated at the infrarenal level, and the patient, who required high-dose inotropic support, was transferred to the intensive care unit. The patient died in the eighth postoperative hour. To our knowledge, this case represents a rare and unique complication that has not been previously reported in the literature. By presenting this case, we aim to draw attention to the long-term complications of EVAR and emphasize the importance of open surgery in patients with a high life expectancy.

Chronic type A aortic dissection (AD) following orthotopic heart transplantation in the pediatric population is an exceptionally rare complication. The diagnosis is often made at autopsy. We present the first case of diagnosis and endovascular treatment of chronic type A AD following orthotopic heart transplantation in a child whose symptoms were successfully alleviated through stent implantation in the affected celiac artery.

Our manuscript presents a rare case of idiopathic mesenteric phlebosclerosis (IMP) in a 73-year-old woman who experienced recurrent abdominal pain and diarrhea. Through a detailed clinical investigation, including laboratory tests, colonoscopy, biopsy, and enhanced abdominal CTA, we diagnosed the patient with IMP. Notably, we identified a potential link between the patient's long-term intake of a traditional Chinese herb containing Gardenia Fructus and the development of IMP. This finding is supported by existing literature, which suggests that genipin, a component of Gardenia Fructus, may cause intimal hyperplasia and fibrosis of the venous wall, leading to chronic intestinal ischemia. Our case highlights the importance of considering herbal intake as a potential risk factor for IMP and underscores the need for clinicians to be aware of the potential adverse effects of traditional herbal remedies.

Portal vein thrombosis (PVT) refers specifically to the presence of a thrombus within the main portal vein trunk or its intrahepatic branches. In contrast, portal vein occlusion encompasses a broader spectrum of conditions, including tumor invasion, external compression and disorders that predispose to thrombosis, such as thrombophilia or inflammatory states. Advanced liver disease, particularly cirrhosis, is the most common cause of PVT, primarily due to portal hypertension, altered hemostasis and hemodynamic changes, followed by malignancies and inherited or acquired thrombophilic conditions. In contrast to these common etiologies, our clinical experience has highlighted rare causes of portal vein obstruction associated with typical presentations, which pose diagnostic challenges. Examples include acute PVT during transjugular intrahepatic portosystemic shunt (TIPS) placement and non-thrombotic porto-mesenteric obstruction related to portal venous gas. While these events may appear unexpected, they represent a recognizable group of uncommon causes rather than isolated incidents. PVT can present as an acute or chronic condition: acute thrombosis is characterized by recent thrombus formation and potential intestinal ischemia, whereas chronic thrombosis is associated with long-standing obstruction, cavernous transformation and portal hypertension. This narrative review integrates a comprehensive literature search with clinical experience, with particular emphasis on uncommon etiologies of portal vein obstruction.

An aberrant right subclavian artery (ARSA) is a rare vascular malformation, and the surgical treatment of aortic diseases in patients with ARSA often necessitates the use of specialized techniques depending on the location of its orifice. Herein, we report a case of chronic Stanford type B aortic dissection (TBAD) with ARSA and false lumen perfusion of the abdominal branches; entry tear closure was achieved through thoracic endovascular aortic repair (TEVAR) using a fenestrated stent graft while preserving false lumen perfusion. The patient was a 48-year-old man with a 3-year history of acute TBAD with ARSA. Outpatient computed tomography revealed dissecting aortic aneurysm enlargement (>5 mm) over 6 months. As the celiac and superior mesenteric arteries were supplied by the false lumen and only small re-entry tears were identified in the bilateral external iliac arteries, the risk of intestinal ischemia due to stent-graft closure of the entry tear was recognized. To preserve false lumen perfusion, a new re-entry tear was created using a guidewire and percutaneous transluminal angioplasty balloon catheter under intravascular ultrasound guidance, followed by debranching TEVAR with a Najuta thoracic fenestrated stent graft (Kawasumi Laboratories, Inc., Tokyo, Japan). The patient had an uneventful postoperative course and was discharged on postoperative day 10.

Fecaloma represents an uncommon yet potentially life-threatening consequence of long-standing constipation. It refers to a densely compacted fecal mass that may result in serious sequelae such as intestinal obstruction, compromised bowel perfusion, and perforation. We describe the case of a 68-year-old woman with known chronic constipation and chronic kidney disease who presented with sudden-onset abdominal pain, progressive distension, and clinical features suggestive of a systemic inflammatory response. Computed tomography (CT) demonstrated a sizable fecaloma within the sigmoid colon along with free intraperitoneal air, raising concern for colonic perforation. The patient underwent emergency exploratory laparotomy, which revealed a perforation of the sigmoid colon adjacent to the fecaloma, and a Hartmann's procedure was subsequently performed. The postoperative recovery was uncomplicated, and the patient was discharged in good clinical condition. This report underscores the need to maintain a high index of suspicion for stercoral perforation in elderly patients with chronic constipation who present with an acute abdomen. Prompt diagnosis and timely surgical management are essential, as delayed treatment is linked to significant morbidity and mortality. Heightened clinical awareness of this rare but severe condition may contribute to improved patient outcomes.

Background: Intra-abdominal infections (IAIs) are one of the leading causes of non-traumatic death in emergency surgery units. The appropriateness of empirical antibiotic therapy is fundamental for outcomes and for limiting the spread of resistance. This study aimed to assess the epidemiology and antibiotic resistance patterns of microorganisms recovered from complicated intra-abdominal infections due to colorectal perforation at an Italian University Hospital during a nine-year period. Methods: This study evaluated a cohort of patients subjected to emergency surgery for colonic perforation with collected intrabdominal fluid samples from 2015 to 2024. Patterns of isolated bacteria and antibiotic resistance status were collected and correlated to patient outcomes. Results: 321 patients were enrolled; the average age was 70.2 years. The main diagnoses were complicated diverticulitis (58%), colorectal carcinoma perforation (18%), and acute intestinal ischemia (24%). 80.4% were immunocompromised; average hospital stay (HLOS) was 15.6 days; 60.1% developed postoperative complications. Microbiological cultures were available for 111 patients: 56.7% had mono-microbial infections and 43.3% multi-microbial infections. 53 antibiotics and 9 antifungals were tested, with resistance rates exceeding 20% for many pathogens. Multivariate analyses showed that documented IAIs are associated with longer postoperative hospital stays (p 0.003 CR 8.075) but not with patient mortality (p 0.031). Prolonged HLOS was more commonly observed in patients with polymicrobial infections or infections caused by multi-drug-resistant organisms (p 0.03; p 0.003). Conclusions: Microbiological characteristics of isolated bacteria do not directly influence mortality; however, the presence of polymicrobial infections and resistant pathogens directly affects the duration of hospitalization and often leads to the development of chronic disease conditions.