Majd Khadra M.D.1, Kenan Abou Chaer M.D.1, Brittany Bahri M.D.1, Rida Farook2, Camila Arellano2, Naveed Shaikh M.D.3Affiliations: 1-Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, USA                        2-Wayne State University, School of medicine, Detroit, USA                         3-Internal Medicine, Veterans Affairs Medical Center, Detroit, USAAbstractNotably, instead of the superior mesenteric vein, our case had a novel combination of portal vein thrombosis and Inferior mesenteric vein thrombosis. This patient might have an underlying, undetected thrombophilia because of the presence of both inferior mesenteric vein(IMV) and portal vein thrombosis. 60-75% of mesenteric venous thrombosis cases are thought to be caused by hypercoagulable conditions brought on by heparin use, thrombocytopenia, myeloproliferative disease, and cancer, according to recent research. The usual conditions that are linked to the combination of inferior mesenteric vein and portal vein thrombosis are pancreatitis, diverticulitis, myeloproliferative neoplasms, and malignancies, none of which our patient had.IntroductionA deep-vein thrombosis (DVT) is a blood clot that forms within the deep veins, usually of the leg, but can occur in the arms, mesenteric, portal and cerebral veins. Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, which can lead to increased pressure in the portal vein system and reduced blood supply to the liver.Case PresentationA 75 year old male with past medical history of hypertension, COPD, hyperlipidemia, type 2 diabetes mellitus, GERD, and polysubstance use disorder presented to the emergency department for periumbilical pain. He stated that his stomach was “not feeling right”. He attributed the discomfort to food poisoning. However he denied nausea, vomiting, and diarrhea. He reported normal, formed, non-bloody bowel movements. He denied any family history of blood clotting disorders or hypercoagulability. In the emergency department, the patient was hemodynamically stable with unremarkable lab findings. Our team ordered CT of the abdomen and pelvis [Figure 1 , 2 ] which showed non-occlusive thrombus within the inferior mesenteric vein (IMV) and the proximal branch of the right portal vein. Patient was started on intramuscular Lovenox 70 mg injection twice daily. He was admitted for management and workup of hypercoagulable state. The patient’s hospital course was uncomplicated. He did not require surgical intervention and was discharged to follow up as an outpatient.