Bacterial biofilm is a formidable influencing factor affecting healing of chronic wound. The mechanisms are as diverse as the bacterial species contained in the biofilm. In an altered environment the biofilm accommodates polymicrobial colonies in which micro-organisms undergo phenotypic and genetic changes to sustain adverse environmental influence. Biofilm bacteria inhibits cell proliferation, prevents cell migration and cause cell kill in a number of ways. It is believed that different bacterium has different mode of action through elaboration of various bioactive factors leading to persistence of low-grade inflammation in the wound bed which is predominantly bacteria-centric. Their ability to survive in low oxygen tension allows them to persist in relatively hypoxic conditions in the wound bed and in presence of increased bioburden. Although the biochemical mechanisms of biofilm influence on chronic wound healing are unfolding slowly, it is difficult to develop clinical studies due to ethical concerns. Therefore, most of the accumulated evidence are based on animal models and in vitro studies. This narrative review attempts to focus on the various mechanisms responsible for delayed healing in presence of bacterial biofilms.

HighlightsAcute retrograde jejunogastric intussusception is a rare event.It presents as sudden onset epigastric pain with mass and vomiting in a patient who underwent previous gastric surgery.The treatment of acute jejunogastric intussusception is prompt surgery.Early surgical intervention prevents vascular compromise and bowel gangrene.

A 50-year-old woman with a history of tubal ligation nine years earlier, presented with a complaint of discharge from the scar site. She was found to have an enterocutaneous fistula. The patient underwent an exploratory laparoscopy. The tract excised and primary repair of bowel done. A unique feature of the case is the formation of an enterocutaneous fistula after an extremely long latency due to gauze threads, which has not been previously reported in the literature.

No abstract