A 1-year-old neutered male neutered Ragdoll cat was presented with a 4-week history of hyporexia, intermittent diarrhoea and weight loss. Initial imaging revealed a varying degree of distension of the intestinal loops by echoic fluid/gas and some loops had hyperechoic content with marked echo shadowing. Exploratory laparotomy was recommended but declined. Subsequent clinical deterioration prompted further investigation with CT scan revealing severe dilation of the intestine which was deemed likely secondary to small intestinal foreign body obstruction, and less likely to be secondary to a condition resulting in functional ileus. Surgical exploration revealed severe intestinal distension extending from mid-jejunum to the caecum and the distended portion of the intestine was impacted with hard faecal matter towards the caecum. Surgical resection of the ileum and caecum was performed. Unfortunately, following surgery the patient continued to decline and was euthansied. On post-mortem examination, histhopathology confirmed myopathic instestinal leiomyositis. To our knowledge, this is the first reported case of myopathic intestinal leiomyositis in a cat. This report supports inclusion of pseudo-obstruction as a differential diagnosis in cats with non-obstructive intestinal disease, highlights the need for further investigation to better characterize intestinal pseudo-obstruction in veterinary medicine, and suggests that insights from human medicine may inform diagnostic and disease classification approaches in the interim.

We present a case in which conservative therapy with oral nutritional supplements (ONS) containing calcium beta-hydroxy-beta-methylbutyrate (CaHMB), L-arginine (Arg), and L-glutamine (Glu) was performed for postoperative small intestine-incision site fistula due to suture failure following surgery for intestinal obstruction after a cesarean section and avoided surgery that carried a high risk of short bowel syndrome in short small intestine patient due to multiple surgeries for Crohn's disease. We report the case of a 39-year-old woman patient. She was diagnosed with Crohn's disease at 14 years old and has undergone multiple surgeries in the past. Jejunostomy was created in the remaining 150 cm of her small intestine. Cesarean section was performed due to preterm labor, but subsequently, the patient developed adhesive small bowel obstruction that was resistant to conservative treatment, and an open abdominal operation was performed. During the surgery, two extensive small intestine injuries were identified, but due to concerns about short bowel syndrome resulting from resection, suture reinforcement was performed. However, an intestine-wound fistula developed due to suture failure in the same area. Since the patient wished for conservative treatment, intestinal fluid was continuously aspirated while using a combination drink containing CaHMB, Arg, and Glu (Abound™, Abbott Japan LLC, Tokyo, Japan). After taking Abound™, there was a marked increase in granulation tissue and narrowing of the fistula. Intestinal fluid discharge stopped 13 days after taking Abound™, and the patient began eating on the 16th day. The patient was discharged on the 22nd day, and the wound healed on the 36th day.

Meckel's diverticulum (MD) is one of the most common congenital anomalies of the gastrointestinal tract in children, although it may occasionally be detected in adults. It is typically located within 100 cm of the ileocecal valve in the distal ileum. The diverticulum varies in size and morphology; many patients remain asymptomatic throughout life. In children, the most common clinical presentation is painless gastrointestinal bleeding, followed by intestinal obstruction. Intussusception may also occur. Once complications develop, patients often present with acute abdomen. Failure to establish a timely diagnosis and initiate appropriate management may result in intestinal ischemia or even necrosis. Furthermore, acute intestinal obstruction may obscure the underlying pathology, increasing the risk of misdiagnosis or missed diagnosis on radiologic evaluation. We report a rare case of Meckel's diverticulum complicated by band adhesion resulting in internal hernia and small bowel obstruction, further associated with peritonitis and massive ascites. The diverticulum was located approximately 40 cm proximal to the ileocecal valve. A fibrous diverticular band adhered to adjacent bowel loops, forming a hernia orifice that caused obstruction of the neighboring small intestine and mesentery. The patient underwent surgical resection of the Meckel's diverticulum, partial ileal resection, and end-to-end ileo-ileal anastomosis. The procedure was uneventful, and postoperative recovery was satisfactory. Internal hernia caused by Meckel's diverticulum band adhesion with associated peritonitis and massive ascites is rare. This case broadens the differential diagnosis of pediatric intestinal obstruction without prior abdominal surgery.

Ureteral complications, particularly stenosis and necrosis, represent important challenges following kidney transplant. When endoscopic management fails due to extensive tissue loss, complex surgical reconstruction becomes necessary. We present the case of a 15-year-old female living donor transplant recipient who presented with urosepsis and hydronephrosis shortly after stent removal. After unsuccessful endourological intervention, surgical exploration revealed total ureteral necrosis. We performed a salvage reconstruction using a tapered, isoperistaltic segment of terminal ileum to bridge the defect. At the 3-year follow-up, the patient exhibited excellent graft function with a serum creatinine of 1.1 mg/dL, and imaging confirmed the absence of hydronephrosis. This case demonstrates that ileal ureter interposition serves as a safe and durable salvage technique for managing extensive ureteral defects. This technique offers effective long-term urinary drainage and graft preservation in young recipients when standard reconstructive options are not feasible.

Since their introduction, Hem-o-lok clips (HOLCs) have become widely accepted and increasingly reliable devices among surgeons performing minimally invasive surgery due to their effectiveness in achieving vascular pedicle control and haemostasis. Although HOLCs are generally regarded as safe devices, various complications have been reported. This review aimed to identify and summarise complications occurring at any time following HOLC use, from their initial introduction in January 1999 through December 2025. This literature review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of PubMed (MEDLINE®), Google Scholar™, ResearchGate, and Embase® was performed using predefined search strings and Boolean operators to identify English-language articles reporting complications associated with HOLC use. The most frequently reported postoperative complications associated with HOLCs occurred after prostatectomy, accounting for 66.23% (n = 51) of all reported cases. The second most common postoperative complication was associated with laparoscopic cholecystectomy, representing 14.28% (n = 11) of cases. The most common complication was clip migration to the urinary bladder with stone formation, accounting for 45.45% (n = 35), followed by urinary bladder neck contracture (14.29%; n = 11), clip migration to the ureter and erosion into the collecting system (14.29%; n = 11), erosion into the duodenum/resulting in duodenal ulcer formation (10.39%; n = 8), and common bile duct (CBD) obstruction (including Mirizzi syndrome or CBD stones) (3.89%; n = 3). Other less frequently reported complications, comprising 11.69% (n = 9), included clip migration to the urinary bladder without stone formation, clip migration to the rectum, erosion into the small intestine, transmural migration to the oesophagus, and anastomotic leak following prostatectomy. Although HOLCs are generally considered safe devices, rare but clinically significant complications have been reported. A high index of clinical suspicion is essential for the early recognition and diagnosis of these complications. The management of HOLC-related complications varies according to the site and nature of the complication but most commonly involves endoscopic retrieval. Conservative management may be appropriate in selected asymptomatic patients.

Crohn's disease (CD) remains a significant therapeutic challenge, with limited treatment options and heterogeneous clinical responses. The selective JAK1 inhibitor filgotinib has shown great potential in treating ulcerative colitis but failed to demonstrate consistent efficacy in CD, for reasons that remain unclear. Here, we address this gap using an immunocompetent ex vivo model of precision-cut intestinal slices (PCIS) from CD patients, allowing region-specific analysis of ileal and colonic responses. We reveal that colonic PCIS display strong T cell activation and are highly sensitive to filgotinib, with suppression of Th1/Th17 cytokines, oxidative stress, and STAT signaling ex vivo. In contrast, ileal PCIS exhibited predominantly innate and Th17-driven inflammation, and were less sensitive to JAK1 inhibition. These data provide a potential mechanistic explanation for the limited efficacy of filgotinib in CD clinical trials and established PCIS as a human-relevant ex vivo model for region-specific drug responses, underscoring the importance of developing therapies tailored to different segments of the gut in inflammatory bowel disease.

Adhesiolysis is a technically demanding component of abdominal and pelvic reoperation. Robotic platforms may offer theoretical advantages in complex dissections; however, the clinical evidence specific to robotic adhesiolysis is limited. This review summarizes the current evidence, robotic-specific technical considerations, clinical rationale, patient selection, and future research priorities for robotic surgery in operations requiring adhesiolysis. A targeted narrative review of peer-reviewed literature on adhesion-related morbidity, adhesive small bowel obstruction (ASBO), laparoscopic adhesiolysis, and robotic surgery in patients with adhesions was performed. Current clinical data suggest that robotic surgery may reduce the conversion to open surgery due to adhesions in selected reoperative abdominal surgeries, particularly in expert hands and specific colorectal settings. However, outcomes beyond conversion, such as enterotomy rates, length of stay, and postoperative complications require further investigation. Successful robotic adhesiolysis relies on meticulous technical execution, including safe abdominal access, strategic port mapping, and appropriate instrument selection. Patient selection must carefully distinguish between elective reoperative surgery and emergency ASBO cases. Robotic adhesiolysis is a promising minimally invasive approach. Current evidence supports the cautious use of this approach in carefully selected patients. Future progress depends on standardized reporting, objective adhesion grading, prospective registries, and comparative studies that evaluate clinically relevant outcomes.