The gut–adipose tissue axis plays a crucial role in metabolic health. It is a two-way communication pathway between the gastrointestinal tract and adipose tissue. This axis influences physiological processes vital for maintaining metabolic health, including energy homeostasis, lipid metabolism, and inflammation. Emerging research suggests that the gut microbiota, composed of trillions of microorganisms residing in the intestines, significantly impacts this axis by modulating host metabolism. An imbalance in the gut microbiota (dysbiosis) has been linked to obesity, insulin resistance, and other metabolic disorders. Innovative therapeutic strategies and dietary interventions aimed at modulating the gut–adipose tissue axis have shown encouraging results in improving metabolic health. A deeper critical understanding of the gut–adipose tissue axis is, therefore, essential in understanding the pathophysiology of metabolic disorders so that targeted interventions can be developed to prevent and treat these metabolic disorders. This article highlights the need for integrative approaches that consider both gastrointestinal and adipose functions in metabolic health management.

The gut-adipose tissue axis plays a crucial role in metabolic health. It serves as a two-way communication pathway between the gastrointestinal tract and adipose tissue. This axis influences various physiological processes that are vital for maintaining metabolic health including energy homeostasis, lipid metabolism, and inflammation. Emerging research suggests that the gut microbiota, composed of trillions of microorganisms residing in the intestines, significantly impacts this axis by modulating host metabolism. An imbalance in the gut microbiota (dysbiosis), has been linked to obesity, insulin resistance, and other metabolic disorders. Innovative therapeutic strategies and dietary interventions aimed at modulating the gut-adipose tissue axis, have shown encouraging results in improving metabolic health. A deeper critical understanding of the gut-adipose tissue axis is, therefore, essential in understanding the pathophysiology of metabolic disorders so that targeted interventions could be developed to prevent and treat these metabolic disorders. The article highlights the need for integrative approaches that consider both gastrointestinal and adipose functions in metabolic health management.

A 77-year-old male presented with diarrhoea, weight loss and faeculent vomiting. CT scan identified a stricturing lesion in the transverse colon. The man, however, had no features suggestive of large bowel obstruction. This unusual presentation of faeculent vomiting raised a suspicion of a possible communication between the colon and stomach. A subsequent CT scan with oral contrast confirmed the presence of a gastrocolic fistula. During explorative laparotomy, a transverse colonic tumour communicating into the stomach via the gastrocolic fistula was detected. The patient underwent an extended right hemicolectomy and distal gastrectomy as a palliative measure. A gastrocolic fistula is a rare yet important find and should be recognised as a possible sequel of this disease process.

Gallstone ileus (GSI) is a rare complication of gallstone disease. It occurs as a result of the passage of a stone from the biliary tract into the gastrointestinal tract via an abnormal pathway (bilio-enteric fistula). Chronic inflammatory processes result in gall bladder adhering and subsequently eroding into the intestines, leading to a fistula. It is a surgical emergency seen in the elderly who often present as being unwell, with abdominal pain, distension, and vomiting. Imaging such as a CT scan is diagnostic in confirming small bowel obstruction. Management usually involves relief of obstruction by removing the impacted gallstone. Despite surgical intervention, a small proportion of patients develop recurrent symptoms or recurrent gallstone ileus, usually within a few weeks of initial presentation. The recurrence of symptoms during index admission is extremely rare and can be challenging to diagnose and manage. The morbidity and mortality remain high in elderly patients. We report an 89-year-old patient who presented with small bowel obstruction. The CT scan confirmed gallstone ileus as a result of a stone impacted in the mid-small bowel. The patient had a laparotomy with extraction of the stone. No migrating stones were felt proximally. Five days postoperatively, he developed recurrent gallstone ileus confirmed on a CT scan and had to undergo another surgery to relieve the obstruction. We aim to investigate various management strategies for recurrent gallstone ileus, ranging from the commonly practiced approach of simple stone extraction to more definitive surgical interventions, including fistula repair, which may provide a more comprehensive solution.