Background The underlying mechanism of acute lung injury (ALI) following hemorrhagic shock has not been clearly elucidated. The uncontrolled systemic inflammatory response syndrome (SIRS) following hemorrhagic shock play a pivatol role in the development of ALI, and the gut has been implicated as the motor of SIRS. Objective To introduce the the effects of hemorrhagic shock on the blood perfusion, structure and function of the gut. In addition, gut-derived inflammatory mediators produced during hemorrhagic shock as well as their roles in the pathogenesis of ALI were discussed. Content This brief review summarizes the effects of gut injury following HS on initiating and perpetuating the uncontrolled SIRS, which ultimately leads to ALI. Trend To provide a better understanding of the therapeutic intervenetion on resuscitation to hemorragic shock.