Gutwrench (3.5e Spell)

With a dramatic flourish, you designate an opponent and make an embellished tugging motion, causing the most vital piece of the target’s being to be wrenched out of place. On a failed Fortitude save, the target’s crucial bits are pulled out entirely, killing the creature instantly. This even works against non-living creatures, but not against immaterial or incorporeal ones.

If the target saves successfully, they are nauseated for one round per level. If they are immune to being nauseated, they instead take 1d6 points of damage per level.