Sarcina ventriculi Revisited: A Rare Organism in the Setting of Gastric Dysmotility After Esophagectomy.

Abstract

Background: Sarcina ventriculi is a rare gram-positive, obligate anaerobic coccus that thrives in acidic environments and has been increasingly recognized in association with delayed gastric emptying and gastric stasis. Although often considered an incidental finding, it has been linked to clinically significant complications, including emphysematous gastritis and gastric perforation Ratuapli S. K. (2013), Laass M. W. (2010), Tolentino L. F. (2003), Lam-Himlin D. (2011), Al Rasheed M. R. H. (2016). Recognition of this organism is important because identification relies primarily on histologic examination and may directly influence patient management.

Case presentation: We report a 35-year-old male with a history of poorly differentiated adenocarcinoma of the lower esophagus treated with neoadjuvant chemotherapy followed by Ivor-Lewis esophagogastrectomy. Several months after surgery, he developed dysphagia, abdominal discomfort, and symptoms suggestive of impaired gastric emptying. Endoscopic evaluation demonstrated mucosal inflammation and retained food material at the anastomotic site. Histopathologic examination of biopsy specimens revealed inflamed gastric-type mucosa containing characteristic tetrad and octet packet formations consistent with Sarcina ventriculi, without evidence of recurrent malignancy. The histologic diagnosis was communicated to the treating team and directly guided initiation of targeted antimicrobial therapy with metronidazole in combination with proton pump inhibitors and prokinetic agents. The patient demonstrated significant clinical improvement and remained stable on follow-up.

Conclusion: This case highlights the importance of recognizing Sarcina ventriculi in patients with surgically altered gastrointestinal anatomy and delayed gastric emptying. Histologic identification can have direct therapeutic implications and underscores the need for multidisciplinary communication. Increased awareness of this rare but clinically relevant organism may help prevent potential complications and optimize patient outcomes.