Autopsy and Case Reports
Autopsy and Case Reports
Review Article

Sarcina ventriculi a rare pathogen

Luciano Paludo Marcelino; Dirceu Felipe Valentini Junior; Simone Márcia dos Santos Machado; Pedro Guilherme Schaefer; Raquel Camara Rivero; Alessandro Bersch Osvaldt

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Sarcina ventriculi is a gram-positive bacterium, able to survive in extreme low pH environment. It’s first description dates from 1842, by John Goodsir. Since then, just a few cases have been reported. In veterinary medicine, especially in ruminants, it causes bloating, vomiting, gastric perforation and death of the animal. It is commonly associated with delayed gastric emptying or obstruction to gastric outlet, although it’s pathogenicity in humans is not fully understood. We report two cases with identification of the bacteria in gastric specimens stained with hematoxylin-eosin staining, in different clinical settings. The first patient is a young female patient, presenting cardiac arrest and death after gastric perforation and the second patient an adult male presenting with gastric adenocarcinoma, treated with partial gastrectomy followed by adjuvant chemoradiation. In our literature review, we identified forty-five cases reporting Sarcina ventriculi appearance, with a sudden increase since 2010.


Sarcina, Clostridium, Gastroparesis


1 Holt SC, Canale-Parola E. Fine structure of Sarcina maxima and Sarcina ventriculi. J Bacteriol. 1967;93(1):399-410. PMid:5335898.

2 Lowe SE, Pankratz HS, Zeikus JG. Influence of pH extremes on sporulation and ultrastructure of Sarcina ventriculi. J Bacteriol. 1989;171(7):3775-81. PMid:2738022.

3 Goodsir J. XXIII: history of a case in which a fluid periodically ejected from the stomach contained vegetable organisms of an undescribed form. J Nat Hist. 1843;11(68):125-6.

4 DeBey BM, Blanchard PC, Durfee PT. Abomasal bloat associated with Sarcina-like bacteria in goat kids. J Am Vet Med Assoc. 1996;209(8):1468-9. PMid:8870748.

5 Vatn S, Gunnes G, Nybø K, Juul HM. Possible Involvement of Sarcina ventriculi in canine and equine acute gastric dilatation. Acta Vet Scand. 2000;41(3):333-7. PMid:11126583.

6 Haroon Al Rasheed MR, Kim GJ, Senseng C. A rare case of sarcina ventriculi of the stomach in an asymptomatic patient. Int J Surg Pathol. 2016;24(2):142-5. PMid:26453674.

7 Tolentino LF, Kallichanda N, Javier B, Yoshimori R, French SW. A case report of gastric perforation and peritonitis associated with opportunistic infection by Sarcina ventriculi. Lab Med. 2003;7(7):535-7.

8 Laass MW, Pargac N, Fischer R, Bernhardt H, Knoke M, Henker J. Emphysematous gastritis caused by Sarcina ventriculi. Gastrointest Endosc. 2010;72(5):1101-3. PMid:20538273.

9 Lam-Himlin D, Tsiatis AC, Montgomery E, et al. Sarcina organisms in the gastrointestinal tract: a clinicopathologic and molecular study. Am J Surg Pathol. 2011;35(11):1700-5. PMid:21997690.

10 Ratuapli SK, Lam-Himlin DM, Heigh RI. Sarcina ventriculi of the stomach: a case report. World J Gastroenterol. 2013;19(14):2282-5. PMid:23599657.

11 Sauter JL, Nayar SK, Anders PD, D’Amico M, Butnor KJ, Wilcox RL. Co-existence of Sarcina organisms and helicobacter pylori gastritis/duodenitis in pediatric siblings. J Clin Anat Pathol (JCAP). 2013;1(1):103. PMid:25664331.

12 Tuuminen T, Suomala P, Vuorinen S. Sarcina ventriculi in blood: the first documented report since 1872. BMC Infect Dis. 2013;13:169. PMid:23566207.

13 Kulkarni G, Shen B, Gordon I. P-018 Sarcina Spp infection of the stomach. Inflamm Bowel Dis. 2013;19:S30-1.

14 Louis GB, Singh P, Vaiphei K. Sarcina infection. BMJ Case Rep. 2014;2014:bcr2013201185. PMid:24419638.

15 Kumar M, Bhagat P, Bal A, Lal S. Co-infection of Sarcina and Giardia in a child. Oxf Med Case Rep. 2014;2014(7):118-9. PMid:25988051.

16 Karakuş E, Kirsaclioglu CT. Coincidence of celiac disease with Sarcina infection. Turk J Gastroenterol. 2014;25(Suppl 1):318. PMid:25910360.

17 DiMaio MA, Park WG, Longacre TA. Gastric Sarcina organisms in a patient with cystic fibrosis. Hum Pathol (N Y). 2014;1(3):45-8.

18 Carrigan S, Grin A, Al-Haddad S, et al. Emphysematous oesophagitis associated with Sarcina organisms in a patient receiving anti-inflammatory therapy. Histopathology. 2015;67(2):270-2. PMid:25410912.

19 Bhagat P, Gupta N, Kumar M, Radotra BD, Sinha SK. A rare association of Sarcina with gastric adenocarcinoma diagnosed on fine-needle aspiration. J Cytol. 2015;32(1):50-2. PMid:25948948.

20 Berry AC, Mann S, Nakshabendi R, Kanar O, Cruz L. Gastric Sarcina ventriculi: incidental or pathologic? Ann Gastroenterol. 2015;28(4):495. PMid:26424003.

21 Chougule A, Muthu V, Bal A, et al. Pulmonary Gangrene Due to Rhizopus spp., Staphylococcus aureus, Klebsiella pneumoniae and Probable Sarcina Organisms. Mycopathologia. 2015;180(1-2):131-6. PMid:26022794.

22 Sopha SC, Manejwala A, Boutros CN. Sarcina, a new threat in the bariatric era. Hum Pathol. 2015;46(9):1405-7. PMid:26198746.

23 Medlicott SAC, Adams F. Sarcina Ventricularis complicating a patient status post vertical banded gastroplasty: a case report. J Gastroenterol Hepatol Res. 2015;14(2):1481-4.

24 Darch R, Harrison J, Rashid M. Sarcina ventriculi bacteria in stomach and duodenum of a patient with gastroesophageal obstruction by adenocarcinoma. Journal Univ Surg. 2016;4:46.

25 Bommannan K, Gaspar BL, Sachdeva MU. Pathogenic Sarcina in urine. BMJ Case Rep. 2016;2016:2016. PMid:27737866.

26 Liu L, Gopal P. Sarcina ventriculi in a Patient With Slipped Gastric Band and Gastric Distention. Clin Gastroenterol Hepatol. 2018;16(4):A25-6. PMid:28666946.

27 Behzadi J, Modi RM, Goyal K, Chen W, Pfeil S. Sarcina ventriculi as an Unknown Culprit for Esophageal Stricturing. ACG Case Rep J. 2017;4(1):e118. PMid:29138756.

28 de Meij TGJ, van Wijk MP, Mookhoek A, Budding AE. Ulcerative gastritis and esophagitis in two children with sarcina ventriculi infection. Front Med (Lausanne). 2017;4:145. PMid:28913339.

29 Canan O, Özkale M, Kayaselçuk F. Duodenitis caused by Sarcina ventriculi in a case with Celiac disease and selective IgA deficiency. Cukurova Medical Journal. 2017;42(4):768-70.

30 Alvin M, Al Jalbout N. Emphysematous gastritis secondary to Sarcina ventriculi. BMJ Case Rep. 2018;2018:2018. PMid:29437820.

31 Shetty NU, O’Connell J, Oshilaja OO, Patil DT, Procop GW, Sturgis CD. First documented case of Sarcina in esophageal brushing cytology. Diagn Cytopathol. 2018;46(10):886-7. PMid:30146691.

32 Aggarwal S, Tyagi R, Selhi PK, Garg A, Sood A, Sood N. Coinfection of Sarcina ventriculi and Candida in a patient of gastric outlet obstruction: an overloaded pyloric antrum. Diagn Cytopathol. 2018;46(10):876-8. PMid:30051973.

33 Tintara S, Rice S, Patel D. Sarcina organisms: a potential cause of emphysematous gastritis in a patient with gastroparesis. Am J Gastroenterol. 2019;114(6):859. PMid:30848737.

34 Rohr JM, Eidem ME, Lele SM. First report of Sarcina ventriculi in a pyloric and duodenal brushing specimen. Cytopathology. 2019;30(5):563-4. PMid:31148297.

35 Singh K. Emphysematous Gastritis Associated with Sarcina ventriculi. Case Rep Gastroenterol. 2019;13(1):207-13. PMid:31123448.

36 Hillman L, Jeans P, Whiting P. Gastrointestinal: sarcina ventriculi complicating gastric stasis. J Gastroenterol Hepatol. 2020;35(4):527. PMid:31730238.

37 Bortolotti P, Kipnis E, Faure E, et al. Clostridium ventriculi bacteremia following acute colonic pseudo-obstruction: A case report. Anaerobe. 2019;59:32-4. PMid:31103530.

38 Singh H, Weber MA, Low J, Krishnan U. Sarcina in an adolescent with repaired esophageal atresia: a pathogen or a benign commensal? J Pediatr Gastroenterol Nutr. 2019;69(2):e57.

39 Zare SY, Kubik MJ, Savides TJ, Hasteh F, Hosseini M. A rare case of Sarcina ventriculi diagnosed on fine-needle aspiration. Diagn Cytopathol. 2019;47(10):1079-81. PMid:31293104.

40 Dumitru A, Aliuş C, Nica AE, Antoniac I, Gheorghiță D, Grădinaru S. Fatal outcome of gastric perforation due to infection with Sarcina spp. A case report. IDCases. 2020;19:e00711. PMid:32099809.

41 Heidinger M, Gorkiewicz G, Freisinger O, Brcic I. Ulcerative reflux esophagitis associated with Clostridium ventriculi following hiatoplasty - is antibiotic treatment necessary? A case report. Z Gastroenterol. 2020;58(5):456-60. PMid:32392607.

42 Sergi C, Lam J, Persad R. Clostridium ventriculi Infection in a Child with Phenylketonuria. Ann Clin Lab Sci. 2020;50(1):134-5. PMid:32161022.

43 Lopez CM, Kovler ML, Jelin EB. Case report of extreme gastric distention and perforation with pathologic Sarcina ventriculi colonization and Rett syndrome. Int J Surg Case Rep. 2020;73:210-2. PMid:32702650.

44 Ferrier D. The constant occurrence of Sarcina ventriculi (Goodsir) in the blood of man and the lower animals: with remarks on the nature of sarcinous vomiting. BMJ. 1872;1(578):98-9. PMid:20746505.

45 Beijerinck MW. An experiment with Sarcina ventriculi. In: Proceedings of the Royal Netherlands Academy of Arts and Sciences; 1991; Amsterdam, the Netherlands. Amsterdam, the Netherlands: Johannes Muller; 1911. Vol. 13, pp. 1234-1240.

46 Al Rasheed MR, Senseng CG. Sarcina ventriculi: review of the Literature. Arch Pathol Lab Med. 2016;140(12):1441-5. PMid:27922772.

47 Lawson PA, Rainey FA. Proposal to restrict the genus Clostridium Prazmowski to Clostridium butyricum and related species. Int J Syst Evol Microbiol. 2016;66(2):1009-16. PMid:26643615.

48 Crowther JS. Sarcina ventriculi in human faeces. J Med Microbiol. 1971;4(3):343-50. PMid:5116255.

49 Gaspar BL. The significance of Sarcina in routine surgical pathology practice. APMIS. 2016;124(6):436-43. PMid:26918758.

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