Emphysematous Gastritis with Delayed Gastric Perforation

Sarcina ventriculi is an increasingly common gram-positive coccus, recognized in gastric biopsies, particularly of patients with delayed gastric emptying. It occurs most commonly in adult women and can be identified easily by its characteristic morphologic features, such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell–sized packets, flattened cell walls, and refractile nature on light microscopy. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis, and peritonitis as well as occurring in the background of gastric adenocarcinomas. This review of the literature discusses the clinical features, endoscopy findings, histopathology, ancillary studies, microbiology, pathogenesis, differential diagnosis, treatment, and prognosis of this bacterium based on 19 published cases.

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Sarcina Organisms in the Upper Gastrointestinal Tract: A Report of 3 Cases With Varying Presentations

International Journal of Surgical Pathology ◽

10.1177/1066896919873715 ◽

2019 ◽

Vol 28 (2) ◽

pp. 206-209

Author(s):

Robert Propst ◽

Laura Denham ◽

Jeremy K. Deisch ◽

Tejinder Kalra ◽

Salman Zaheer ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Gastric Perforation ◽

Upper Gastrointestinal Tract ◽

Histopathologic Examination ◽

Clinical Presentations ◽

Emphysematous Gastritis ◽

Upper Gastrointestinal ◽

Gram Positive Cocci

Sarcina species are anaerobic gram-positive cocci rarely seen in the upper gastrointestinal tract and associated with delayed gastric emptying. We present 3 cases of Sarcina infection with varying clinical presentations including the first reported case of Sarcina in a patient with eosinophilic esophagitis. Although the pathogenesis of Sarcina is unclear, awareness of the bacteria is important as they can usually only be detected on histopathologic examination of upper gastrointestinal biopsies. Treatment in symptomatic patients may prevent severe complications such as emphysematous gastritis and gastric perforation.

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Sarcina ventriculi: A Rare Case of Life-Threatening Perforated Gastric Ulcer and Review of Literature

Journal of Gastric Surgery ◽

10.36159/jgs.v2i2.36 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Qing Wei ◽

Sixto Leal ◽

Morad Qarmali ◽

Charles Mel Wilcox ◽

Chirag Patel ◽

...

Keyword(s):

Gastric Perforation ◽

Gastrointestinal Surgery ◽

Outlet Obstruction ◽

Gastric Surgery ◽

Gastric Ulcers ◽

Resected Stomach ◽

Sarcina Ventriculi ◽

Emphysematous Gastritis ◽

Life Threatening ◽

History Of

Sarcina ventriculi is a gram-positive anaerobic bacterium reported rarely in patients with a history of gastrointestinal surgery and delayed gastric emptying. Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis, and gastric perforation. So far, less than 30 cases of Sarcina isolated from gastric specimens have been reported, including 3 cases associated with life-threatening illness: emphysematous gastritis and gastric perforation. Herein, we report a case of a 58-yearold woman with history of gastric surgery who presented for evaluation of persistent gastric pain and incurable ulcer. She underwent total gastrectomy, and the resected stomach demonstrated a perforated ulcer with the presence of Sarcina microorganisms. We also report a second case of a 56-year-old woman with history of NSAID use who presented with gastric outlet obstruction. The gastric biopsy identifi ed concurrent Helicobacter pylori and Sarcina. Given Sarcina‘s association with emphysematous gastritis and gastric perforation, its identifi cation on gastric biopsies should be clearly stated in pathology reports and, depending on the clinical scenario, prompt clinicians to add adjunctive antimicrobials to anti-ulcer therapeutic regimens.

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Postmortem Diagnosis of Gastric Ulcer Perforation and Peritonitis with Sarcina Ventriculi: A Case Report

The Bulletin of Legal Medicine ◽

10.17986/blm.2019149824 ◽

2019 ◽

Vol 24 (1) ◽

pp. 80-82

Author(s):

Aytül Buğra ◽

Taner Daş ◽

Neval Elgörmüş ◽

Gizem Ayaz

Keyword(s):

Gastric Ulcer ◽

Delayed Gastric Emptying ◽

Gastric Perforation ◽

Histopathological Examination ◽

Case Reports ◽

Postmortem Diagnosis ◽

Sarcina Ventriculi ◽

Ulcer Perforation ◽

Emphysematous Gastritis ◽

Life Threatening

Sarcina ventriculi is a gram-positive anaerobic coccus with characteristic tetrad morphology. Sarcina ventriculiis identified by light microscopy with features of basophilic staining, cuboidal shape, tetrad morphology, and refractile nature. There have been very few case reports of Sarcina ventriculi reported in the literature. We present a case of a 53-year-old male, with gastric ulcer perforation where peritonitis was incidentally found to harbor Sarcina ventriculi in postmortem histopathological examination. Most of the cases exhibit abdominal pain, nausea, vomiting and delayed gastric emptying. It has also fatal life-threatening complications, such as gastric perforation and emphysematous gastritis. The histopathological examination has a key role for identification of the bacteria. The pathologist must always keep it in mind these bacteria as a cause of gastric ulcer perforation in the differential diagnosis. We want to present a case of a 53-year-old male gastric ulcer perforation who was found dead in his bed.

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