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23 year-old male with no known co-morbidities came to the ER with exacerbation of his chronic 4 years' history of abdominal pain, vomitting and weight loss. I/V line was maintained and symptomatic treatment initiated. Relevant work-up and imaging was done. CT abdomen showed completely thrombosed splenic vein, proximal superior mesenteric vein, and portal vein without evidence of hepatic,splenic or bowel infarction; bulky uncinate process and head of pancreas suggestive of pancreatitis, multiple enlarged mesenteric lymph nodes with few subcentimeter retroperitoneal lymph nodes, moderate ascites, splenomegaly, thickened walls of stomach, ascending colon, and proximal transverse colon, with moderate to large right and mild left-sided pleural effusion. General Surgery and /ascular Surgery teams were on-board and recommended to continue the patient on oral anti-coagulation as nrombectomy was not an option at the time due to active infection. Acute Pain Management team was also seeing the pa