Acute Bowel Gangrene after Glyphosate Herbicide Ingestion: An Unusual Cause of Surgical Abdomen

Glyphosate-based herbicides (GlyBH) are widely used worldwide and are generally considered to have low acute toxicity in humans. However, increasing evidence suggests that exposure to concentrated formulations, especially those containing surfactants such as polyoxyethylene amine, can result in severe systemic toxicity. Gastrointestinal manifestations are usually limited to mucosal injury, and bowel gangrene following glyphosate ingestion has not been previously described in the literature. We report a fatal case of acute GlyBH poisoning in a 17-year-old male who presented 14 h after ingestion with severe abdominal pain and metabolic acidosis. Clinical examination and radiological findings were suggestive of peritonitis, prompting emergency exploratory laparotomy. Intraoperatively, extensive gangrene of the small bowel was identified, with patchy involvement of the cecum and spleen. The patient underwent damage control bowel resection followed by a relook surgery with ileocolic resection and end ileostomy. Although initially stabilized postoperatively, he subsequently developed acute respiratory distress syndrome, acute kidney injury, severe thrombocytopenia, hospital-acquired pneumonia, and mixed septic and cardiogenic shock. Echocardiography revealed severe left ventricular dysfunction. Despite aggressive intensive care management and supportive therapy, the patient showed progressive clinical deterioration and died on postoperative day 20. This case highlights bowel gangrene as an exceptionally rare and previously unreported complication of GlyBH poisoning. It emphasizes the potential for catastrophic gastrointestinal and multisystem toxicity following ingestion and the importance of early recognition, aggressive supportive treatment, and close intensive monitoring in severe cases.