Intestinal ischemia/reperfusion (I/R) injury is a critical clinical syndrome precipitated by the restoration of blood flow following intestinal ischemia, a common occurrence in perioperative settings such as abdominal aortic surgery, hemorrhagic shock, and cardiopulmonary bypass. This injury extends beyond the local gut, as the disruption of the intestinal mucosal barrier facilitates bacterial and endotoxin translocation into the systemic circulation, triggering a systemic inflammatory response that can progress to sepsis and multiple organ dysfunction syndrome (MODS). Despite advances in critical care, the mortality rate associated with severe intestinal I/R injury remains formidable. The microcirculatory disturbances and organ damage following intestinal I/R involve complex pathological processes, including metabolic injury and oxidative stress. In recent years, rapid developments in the understanding of cell death mechanisms, gut microbiota, microRNAs, and fundamental medical technologies have significantly advanced research on the prevention and treatment of I/R injury. This review aims to comprehensively summarize the occurrence and progression of intestinal I/R, its impact on extraintestinal organ injury, diagnostic strategies and biomarkers, as well as current treatment methods, thereby providing guidance for the future prediction, diagnosis, and treatment of intestinal I/R injury.