Résumé
Sarcina Ventriculi is a gram-positive anaerobic coccus rarely reported in patients with delayed gastric emptying, emphysematous gastritis, gastric ulcers, and perforation. So far, less than 30 cases of sarcina isolated from the stomach have been reported. Herein, we describe a case of a 66-year-old male with a history of persistent epigastric pain and regurgitation. The upper gastrointestinal (GI) endoscopy revealed gastric erythema, edema, ulceration, and food bezoar. A gastric biopsy was done to rule out lymphoma. On histopathological examination, sarcina Ventriculi was identified. This organism is likely to get underreported as it may not be that obvious on routinely stained biopsies. Given its association with life-threatening illness such as emphysematous gastritis and perforation, awareness of this organism is important. It's presence in gastric biopsies must be mentioned in the report and should prompt the clinicians to investigate further for functional causes of delayed gastric emptying and gastric outlet obstruction like occult malignancy.
Résumé
Background: Sarcina ventriculi, a gram-positive coccus, are occasionally found in gastric biopsies. Although Sarcina had been described more than 150 years ago, little is known about its pathogenicity in humans. Method: This retrospective case series included patients who were identified with Sarcina infection. We report clinicopathologic characteristics of 13 patients with Sarcina in gastric or duodenal biopsies. Result: The presenting symptoms included: epigastric discomfort (n=6), epigastric pain (n=4), anorexia (n=6), nausea and vomiting (n=5), constipation (n=2), diarrhoea (n=2) and weight loss (n=3).All patients had evidence of mucosal injury.Sarcina was found on mucosal surface.12 patients had food residue on oesophagogastroduodenoscopy (OGD). 10 patients had gastric outlet obstruction (GOO), antral narrowing in 7 and duodenal obstruction in 3. 6 patients had malignant GOO. Causes of benign GOO included Helicobacter Pylorigastritis (n=1), eosinophilic gastritis (n=1) and duodenal ulcers (n=2, 1 NSAIDs). Of the 5 patients that had follow-up OGD, 2 had gastric residue. One patient had recurrence of symptoms with the persistence of sarcina on biopsy at 3 months. Symptoms improved at 6 months and no evidence of sarcina on biopsy at 6 months. Conclusion: Our findings suggest GOOcan be considered as a predisposing factor for Sarcina infection. Sarcina infection may not be the aetiology for GOObut may complicate recovery and may lead to life-threatening complications. Clinicians and pathologists must be aware of such microorganisms and must be documented in the histology report for further investigation and therapeutic consideration.