ABSTRACT
First identified in humans by Goodsir in 1842, Sarcina were already known to cause fatal abomasal bloat in animals. Their pathogenicity in humans has only recently been characterized. Sarcina is not inherently pathogenic but, with a gastric ulcer and delayed gastric emptying, can result in perforation. We present a case report of a 32-year-old woman status post-gastric banding presenting with epigastric pain. Upper endoscopy revealed a gastric ulcer near the band. After deflation, upper gastrointestinal series showed passage of contrast and no perforation. Ulcer biopsy showed gastric contents composed of Sarcina. Proton pump inhibitors and antibiotics were administered. Follow-up endoscopy at an outside institution resulted in perforation. This case report supports a growing body of literature that Sarcina organisms contribute to ulcers and perforation. This is the first report of Sarcina in elective bariatric surgery patients, highlighting the high suspicion needed among pathologists evaluating ulcers in this unique surgical population.
Subject(s)
Bariatric Surgery/adverse effects , Gram-Positive Bacterial Infections/microbiology , Sarcina/isolation & purification , Stomach Ulcer/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Biopsy , Female , Gastroscopy , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Proton Pump Inhibitors/therapeutic use , Sarcina/pathogenicity , Stomach Ulcer/diagnosis , Stomach Ulcer/drug therapy , Treatment OutcomeABSTRACT
Celiac axis stenosis caused by extrinsic compression by the median arcuate ligament (MAL) is present in up to 5% of patients undergoing pancreaticoduodenectomy. Failure to identify and manage MAL compression can lead to potentially devastating postoperative consequences that include frank liver necrosis and death. We report an incidental discovery of celiac axis stenosis by MAL in a patient prepared for pancreaticoduodenectomy. Image findings and operative management are discussed.
