Deep vein thrombosis (DVT) of the lower extremities is a common yet preventable perioperative complication in patients undergoing gastrointestinal surgery, which may progress to life-threatening pulmonary embolism (PTE). Gastrointestinal surgical patients often present with complex disease profiles, frequently complicated by malignancy, intestinal obstruction, intra-abdominal infection, inflammatory bowel disease, malnutrition, preoperative bowel preparation, perioperative fasting, postoperative mobility limitations, and risks of gastrointestinal or anastomotic bleeding. These factors result in a prolonged coexistence of both thrombotic and bleeding risks. In recent years, advances in enhanced recovery after surgery, laparoscopic and robotic techniques, electronic risk assessment systems, machine learning prediction models, and novel anticoagulants have gradually shifted management of venous thromboembolism (VTE) in gastrointestinal surgery from empirical prevention toward stratified, dynamic, and individualized approaches. This review focuses on the epidemiological characteristics, specialized pathogenesis, risk factors, risk assessment tools, preventive strategies, diagnostic-treatment integration, and quality management of perioperative DVT in gastrointestinal surgery, with particular emphasis on controversies such as the "ceiling effect" of the Caprini score, the safety of direct oral anticoagulants following gastrointestinal cancer surgery, and the appropriate patient populations for extended prophylaxis. The authors argue that perioperative DVT management in gastrointestinal surgery should not rely solely on single scoring systems or fixed anticoagulation protocols, but instead adopt a closed-loop model integrating baseline scoring, specialty-specific variables, bleeding risk, dynamic reassessment, and post-discharge follow-up, aiming to provide guidance for standardized clinical prevention and treatment.