Vascular cognitive impairment (VCI) is a major form of dementia with a complex pathogenesis. Emerging evidence indicates a strong interaction between intestinal mucosal barrier integrity and neuroinflammation, which has been proposed as a candidate contributor in VCI progression. This review comprehensively reviews the initiation and amplification of neuroinflammation in chronic cerebral ischemia. It highlights how impairment of the intestinal mucosal barrier, gut microbiota dysbiosis, and translocation of microbial metabolites contribute to central neuroinflammation via circulatory and neural pathways, suggesting a potential self-sustaining pathological cycle within the gut-brain axis. Furthermore, we analyze the underlying molecular mechanisms, critique current limitations, and suggest promising directions for future research.

Intestinal malrotation is a congenital anomaly of midgut rotation and fixation that typically manifests in infancy, with most cases diagnosed within the first year of life. Although rare, accounting for ~0.2%-0.5% of all malrotation cases, intestinal malrotation can present in adults, with nonspecific symptoms that may delay diagnosis. We report the case of a 48-year-old male with a four-year history of recurrent colicky abdominal pain and non-bilious vomiting that progressively worsened over the preceding three months, with vomiting increasing to nearly ten episodes daily. A contrast-enhanced abdominal computed tomography demonstrated marked dilatation of the proximal duodenum with a transition point at the mid-duodenum suggestive of a partial obstruction. Upper gastrointestinal fluoroscopy confirmed midgut malrotation with an incomplete volvulus. The patient subsequently underwent a Ladd procedure. Adult midgut malrotation should be considered in patients with chronic, unexplained abdominal pain and vomiting. Early diagnosis is essential to prevent life-threatening complications such as a volvulus and bowel ischemia.

We report a case of acute-on-chronic mesenteric ischemia (AOCMI) in an 85-year-old woman presenting with progressive postprandial abdominal pain, signs of panperitonitis, and free intraperitoneal air. Emergency laparotomy revealed diffuse small bowel ischemia without clear demarcation, reflecting acute ischemia superimposed on chronic hypoperfusion. Intraoperative indocyanine green (ICG) fluorescence angiography enabled selective resection of nonviable bowel, preserving potentially salvageable intestine. Delayed recognition of a nine-month history of chronic mesenteric ischemia (CMI) prompted staged endovascular revascularization of the superior mesenteric artery (SMA). Despite transient short bowel syndrome (SBS) requiring parenteral nutrition, bowel continuity was ultimately restored. This case highlights the diagnostic challenge of AOCMI and demonstrates that selective bowel salvage combined with staged multidisciplinary intervention can preserve bowel function and quality of life even in elderly high-risk patients.

The case of an 88-year-old male patient with progressive, unintentional weight loss is reported. The condition was subjectively asymptomatic and subsequently completely reversible. Following a comprehensive internal medicine examination, chronic mesenteric ischemia due to arteriosclerosis was identified as the cause and treated interventionally. Over time, the patient experienced significant weight gain, a comparatively rare phenomenon in very old geriatric patients. Broad and targeted investigation of the cause and interventional therapies are safe and feasible even in old age.

Kidney ischemia-reperfusion (I/R) injury is an unavoidable complication of kidney transplantation that contributes to acute kidney injury (AKI), chronic kidney disease (CKD), and limited long-term graft survival. Elevated serum phosphate has been implicated not only as a consequence of renal dysfunction but also as an active mediator of kidney injury. Tenapanor, an intestinal sodium/hydrogen exchanger 3 inhibitor approved for the treatment of hyperphosphatemia in dialysis patients, may therefore have renoprotective potential; however, its effects on renal I/R injury remain unclear. Here, we show that oral administration of tenapanor suppresses renal calcium phosphate deposition after I/R, mitigates AKI progression, and reduces subsequent renal fibrosis in rats. These findings suggest that tenapanor mitigates renal I/R injury and may represent a potential pre-transplant strategy to improve long-term graft outcomes.

Lung injury is one of the most common clinical respiratory diseases, caused by the exposure of lung tissue to various stimuli (including hypoxia, ischemia-reperfusion, and foreign substances). Among them, chronic lung injury is characterized by continuous inflammation in the lungs, which damages the endothelial and epithelial cell barriers within the lungs. Clinically, it presents as severe hypoxia and diffuse functional impairment, and on imaging, it shows diffuse alveolar damage, accompanied by varying degrees of inflammation and airway obstruction. Several studies have highlighted the role of gut microbiota in modulating immune responses and pathological features of respiratory diseases through the gut-lung axis. However, the precise metabolic mechanism remains unknown. A lung injury model was generated by transplanting microbiota from acute lung injury (ALI) patients into healthy C57BL/6J mice. The changes in the gut microbiota and metabolic phenotypes of the feces samples from ALI patients and lung-injured mice were analyzed using 16S rRNA sequencing technology and metabolomics based on 1H-nuclear magnetic resonance (1H-NMR), respectively. The effect of gut microbiota on lung injury was also explored after giving an oral vancomycin treatment to lung-injury mice. The data presented here show that Firmicutes formed the vital species of microbiota that was different in lung-injury mice. Moreover, butyrate (produced by Firmicutes) was the most crucial metabolite in the feces samples of ALI patients and lung-injury mice. ELISA and Hematoxylin-Eosin results showed aggravated functional disturbances in the intestinal barrier of ALI patients and lung inflammation in the lung-injured mice. These phenomena were significantly alleviated after the oral administration of vancomycin. Besides, the utilization of butyrate in the colon of mice was increased considerably. Thus, vancomycin can affect the metabolism of butyrate in the colon by influencing the intestinal microbiota, and it can help in the treatment of lung injury.

Background and Clinical Significance: Chronic intestinal pseudo-obstruction (CIPO) clinically presents as a mechanical obstruction. When patients present with signs of impending ischemia, emergency exploratory laparotomy is indicated. Differentiating CIPO from other etiologies preoperatively is highly challenging, making intraoperative findings and definitive histopathology crucial for an accurate diagnosis. This report aims to elucidate a novel macroscopic presentation of myopathic CIPO and explore the potential biomechanical mechanisms underlying the observed structural anomaly. Case Presentation: A 37-year-old male with no prior abdominal surgery presented with a high-grade bowel obstruction and early signs of ischemia. Emergency laparotomy revealed a unique "braided dough twist" anomaly of the distal small bowel, prompting a segmental resection. Subsequent histopathological and immunohistochemical evaluations revealed severe outer longitudinal muscle atrophy with an intact enteric nervous system, confirming myopathic CIPO. Following surgery, the patient recovered uneventfully with significant nutritional improvement. Conclusions: Myopathic CIPO can manifest as a striking "braided" bowel anomaly-a macroscopic presentation previously undocumented in the literature. This case illustrates that determining the optimal extent of resection relies heavily on intraoperative visual and tactile assessment, and that comprehensive histopathological profiling is essential for establishing a definitive diagnosis and elucidating the underlying biomechanical mechanisms of this unique structural anomaly.

A Japanese man in his 60 s with end-stage kidney disease due to diabetic nephropathy, who initially underwent peritoneal dialysis (PD) and was transferred to combined PD and hemodialysis (HD) therapy 4 years prior, was admitted to our hospital for surgical treatment of lumbar spinal canal stenosis. His rehabilitation continued well after successful surgery; however, he suddenly presented with abdominal pain and cloudy peritoneal dialysate, along with an increased white blood cell count in the peritoneal dialysate effluent, suggesting PD-associated peritonitis. Intraperitoneal administration of antibiotics was ineffective, and contrast-enhanced computed tomography showed areas of poor contrast enhancement and pneumatosis intestinalis in the colon. Emergency laparotomy revealed non-occlusive mesenteric ischemia (NOMI), leading to intestinal resection with ileostomy creation. He made good progress after the surgery and was eventually discharged while receiving thrice-weekly HD. NOMI is a well-known life-threatening condition, and its outcomes in patients receiving dialysis therapy are reportedly unfavorable. Furthermore, to our knowledge, there have been no reported cases of NOMI in patients receiving combined PD and HD therapy. Further accumulation of similar cases is needed to clarify appropriate approaches for treating NOMI in these patients.

Blunt bowel and mesenteric injuries (BBMI) are diagnostically challenging and may evolve despite apparent radiological resolution. This case describes biphasic small bowel perforation following non-operative management (NOM) after blunt abdominal trauma, highlighting limitations of conservative strategies and the need for prolonged vigilance. A 57-year-old woman sustained a Grade 4 small bowel perforation after a motor vehicle collision. She presented 7 days post-accident with abdominal pain but was haemodynamically stable and elected NOM. Interval computed tomography at 23 days demonstrated apparent resolution. At 21 weeks, she re-presented with crescendo abdominal pain, nausea, and vomiting. Imaging confirmed recurrent perforation at the original site. Laparotomy revealed a 3 cm full-thickness perforation adjacent to a chronic fibrotic stricture and mesenteric defect. Ileocolic resection was performed. Radiological resolution does not equate to definitive healing in high-grade BBMI. Trauma-induced chronic ischaemia may drive delayed stricture formation and late perforation, warranting structured long-term follow-up, and patient education.

BACKGROUND Small bowel obstruction (SBO) is a common surgical emergency, most frequently caused by postoperative adhesions or hernias. SBO resulting from migration of an intrauterine device (IUD) is exceedingly rare but can be life‑threatening. CASE REPORT We present 2 cases of postmenopausal women with long-term IUD retention (>30 years) who developed acute abdominal pain and clinical signs of intestinal obstruction. Preoperative abdominal CT revealed dilated small bowel loops with surrounding fluid and inflammatory changes, along with an ectopic ring-shaped IUD through which a segment of ileum herniated. Emergency laparotomy confirmed a strangulated obstruction and necrotic bowel in both cases, which required segmental bowel resection and primary anastomosis. Postoperative recovery was uneventful in both patients. A review of the literature indicates that such complications predominantly occur in postmenopausal women. Prolonged device retention, particularly with O-shaped IUDs, is associated with older age at presentation. Progressive uterine atrophy and myometrial thinning after menopause increase the risk of chronic erosion and eventual perforation with intraperitoneal migration. If the IUD is not encapsulated by the omentum, it provides an opportunity for small bowel loops to herniate through its central opening, ultimately resulting in strangulated intestinal obstruction. CONCLUSIONS These cases highlight the importance of recognizing IUD migration as a rare cause of mechanical small bowel obstruction, especially in women with a remote history of IUD placement. Prompt imaging evaluation and timely surgical intervention are critical to prevent bowel ischemia and reduce morbidity.