Delayed gastric emptying and microorganisms in tetrads

Maxine Andrea Garcia; Enrik John Aguila; Ma Regina Dimaculangan; Ian Homer Cua

doi:10.5946/ce.2024.137

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Image of Issue Delayed gastric emptying and microorganisms in tetrads: Maxine Andrea Garcia, Enrik John Aguila^,, Ma Regina Dimaculangan, Ian Homer Cua; DOI: https://doi.org/10.5946/ce.2024.137
Published online: November 5, 2024

Institute of Digestive and Liver Diseases, St. Luke’s Medical Center Global City, Taguig City, Philippines

Correspondence: Enrik John Aguila Institute of Digestive and Liver Diseases, St. Luke’s Medical Center Global City, Rizal Drive cor. 32nd St. and 5th Ave., Taguig City, Metro Manila, Philippines, 1634 +639458010429 E-mail: enrikaguila@gmail.com

• Received: May 25, 2024 • Revised: June 5, 2024 • Accepted: June 8, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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An 83-year-old woman with a stage IV ovarian adenocarcinoma presented with a 1-week history of recurrent vomiting and intermittent cramping abdominal pain. A positron emission tomography scan performed a few months prior revealed enhancing hypermetabolic nodules in the greater curvature and pylorus of the stomach. Computed tomography performed upon admission revealed stomach distension and irregular pyloric wall thickening causing severe narrowing (Fig. 1). Subsequent esophagogastroduodenoscopy revealed a fluid-filled stomach, and 1.1 L of content was suctioned despite a fast exceeding 24 hours (Fig. 2). Other findings included esophagitis, diffuse erosive gastritis, and severely edematous pyloric channels. There were no endoscopic findings of tumor infiltration, and a scope was used to intubate the pylorus with insufflation. Targeted mucosal biopsies (Fig. 3) revealed mild chronic inflammation with bacterial organisms in tetrads compatible with Sarcina ventriculi (Fig. 4), a commensal gram-positive anaerobic bacteria that thrives at a very low pH.¹ Few cases have been published; in most reports, infection was associated with delayed gastric emptying from gastroparesis or pyloric stenosis.² In cases of co-existent mucosal damage, infection has been associated with emphysematous gastritis, ulcers, and even perforations.³ In our immunocompromised patient, the S. ventriculi overgrowth probably resulted from prolonged exposure to a low pH environment due to the delayed gastric emptying. The resulting inflammation further exacerbates the impaired gastric motility. A diagnosis is achieved through histopathologic identification, and antibiotic treatment reduces complications.² During treatment with metronidazole and piperacillin tazobactam, her symptoms improved, and a soft diet was tolerated with no recurrence of the vomiting. Endoscopy with repeat biopsies performed 1 month later confirmed infection eradication, inflammatory resolution, and reduced pyloric edema. This case demonstrates that targeted mucosal biopsies should be performed in immunocompromised patients with delayed gastric emptying and mucosal inflammation. The detection of S. ventriculi should alert clinicians of its underlying cause and prompt treatment to prevent potential severe complications.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Acknowledgments

Informed consent was obtained for the publication of this case report.

Author Contributions

Conceptualization: EJA; Data curation: MAG, MRD; Supervision: EJA, IHC; Writing–original draft: MAG, MRD; Writing–review & editing: EJA, IHC.

Fig. 1.

Abdominal computed tomography scan performed at the level of the pylorus and stomach showing stomach distension and irregular wall thickening in the pylorus.

Fig. 2.

Endoscopic view of the gastric body showing a distended fluid-filled stomach.

Fig. 3.

Targeted biopsies were taken from: (A) the edematous pyloric opening; and (B) a hyperemic patch at the greater curvature of the stomach.

Fig. 4.

Microorganisms within the tetrads found during the gastric mucosal biopsy (H&E stain, HPO 40× magnification).

REFERENCES

1. Ratuapli SK, Lam-Himlin DM, Heigh RI. Sarcina ventriculi of the stomach: a case report. World J Gastroenterol 2013;19:2282–2285.Article PubMed PMC
2. Tartaglia D, Coccolini F, Mazzoni A, et al. Sarcina Ventriculi infection: a rare but fearsome event: a systematic review of the literature. Int J Infect Dis 2022;115:48–61.Article PubMed
3. Savić Vuković A, Jonjić N, Bosak Veršić A, et al. Fatal outcome of emphysematous gastritis due to Sarcina ventriculi Infection. Case Rep Gastroenterol 2021;15:933–938.Article PubMed PMC PDF

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Delayed gastric emptying and microorganisms in tetrads

DOI: https://doi.org/10.5946/ce.2024.137

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Figure

Delayed gastric emptying and microorganisms in tetrads

Fig. 1. Abdominal computed tomography scan performed at the level of the pylorus and stomach showing stomach distension and irregular wall thickening in the pylorus.

Fig. 2. Endoscopic view of the gastric body showing a distended fluid-filled stomach.

Fig. 3. Targeted biopsies were taken from: (A) the edematous pyloric opening; and (B) a hyperemic patch at the greater curvature of the stomach.

Fig. 4. Microorganisms within the tetrads found during the gastric mucosal biopsy (H&E stain, HPO 40× magnification).