Sarcina ventriculi is an increasingly common gram-positive coccus, recognized in gastric biopsies, particularly of patients with delayed gastric emptying. It occurs most commonly in adult women and can be identified easily by its characteristic morphologic features, such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell-sized packets, flattened cell walls, and refractile nature on light microscopy. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis, and peritonitis as well as occurring in the background of gastric adenocarcinomas. This review of the literature discusses the clinical features, endoscopy findings, histopathology, ancillary studies, microbiology, pathogenesis, differential diagnosis, treatment, and prognosis of this bacterium based on 19 published cases.