Herbicide poisoning causing multiple colonic perforations: case report

Herbicide poisoning, particularly from 2,4-dichlorophenoxyacetic acid (2,4-D), is an uncommon yet significant cause of systemic toxicity, especially in agricultural regions such as Ethiopia. Patients exposed to 2,4-D frequently exhibit symptoms associated with gastrointestinal, muscular, renal, and neurological toxicity. In this report, we describe a case of 2,4-D ingestion that resulted in systemic complications and the exceptionally rare occurrence of multiple colonic perforations.

A 19-year-old male farmer presented with a loss of consciousness three hours after attempting suicide by ingesting 25 ml of 72% 2,4-D solution. This was preceded by vomiting and epigastric pain. The patient was treated for hypovolemic shock, aspiration pneumonia, and coma secondary to herbicide poisoning. Despite initial stabilization and recovery, the patient developed signs of peritonitis 14 days post-ingestion, which led to the discovery of multiple colonic perforations. Surgical intervention included total colectomy with ileostomy, which was later reversed. This case is notable as the first documented instance of multiple colonic perforations due to 2,4-D poisoning in humans, as confirmed through an extensive literature review.

This case highlights the importance of vigilance in patients presenting with herbicide poisoning, as early detection and prompt management are essential for improving outcomes in individuals with multiple colonic perforations. Raising community awareness and establishing guidelines for the safe use of herbicides are vital to preventing such incidents.