Successful treatment of acute organophosphorus pesticide poisoning complicated by intestinal necrosis with exploratory laparotomy: a case report

Objectives: Acute organophosphorus pesticide poisoning (AOPP) constitutes a common yet life-threatening emergency, particularly prevalent in rural regions of Asia. The condition results from inhibited cholinesterase activity, which induces acetylcholine accumulation at neural synapses. Clinically, its manifestations are categorized into muscarinic, nicotinic, and central types. Among these, mortality typically arises from respiratory paralysis, while neurological sequelae are frequently encountered. Nevertheless, reports of AOPP-induced intestinal necrosis remain exceedingly uncommon both domestically and internationally. Case presentation: In the present case, the patient experienced acute poisoning following oral ingestion of a high dose of dichlorvos. Despite initial standardized management, including atropine administration, pralidoxime therapy, and hemoperfusion, complications such as toxic encephalopathy and multiple organ dysfunction ensued. During hospitalization, acute peritonitis developed, and abdominal computed tomography revealed intestinal perforation accompanied by peritonitis. Exploratory laparotomy confirmed small intestinal necrosis and perforation of the ascending colon, necessitating resection of the necrotic segment and enterostomy. Postoperatively, the patient was transferred to the emergency intensive care unit for comprehensive supportive treatment and subsequently achieved full recovery before discharge. Conclusions: This case highlights that in patients with severe organophosphorus poisoning, any unexplained alteration in abdominal signs should prompt high clinical suspicion of gastrointestinal complications, and prompt surgical intervention may be lifesaving. However, as a single case report, this study carries inherent limitations, and future large-scale investigations remain essential to further substantiate these findings and develop more effective therapeutic strategies to enhance the overall management of AOPP.