title: Sarcina, a new threat in the bariatric era.
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.
authors.affiliation: Department of Pathology, University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD 21061. Electronic address: ssopha@bwmc.umms.org.
authors.forename: Sabrina C
authors.initials: SC
authors.lastname: Sopha
authors.affiliation: Department of Gastroenterology, University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD 21061.
authors.forename: Alif
authors.initials: A
authors.lastname: Manejwala
authors.affiliation: Department of Surgery, University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD 21061.
authors.forename: Cherif N
authors.initials: CN
authors.lastname: Boutros
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000009:adverse effects*; D001706:Biopsy; D005260:Female; D005773:Gastroscopy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012505:Sarcina / Q000302:isolation & purification* / Q000472:pathogenicity; D013276:Stomach Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Bariatric; Delayed gastric emptying; Perforation; Sarcina; Ulcer