Highlights MVT with acute appendicitis is a rare event, often with delayed presentation. Incidence of MVT in patients presenting with acute appendicitis was 0.25 %. Initial management included heparin infusion, antibiotics, bowel rest and IV fluids. Each patient was treated with 3–6 months of anticoagulation from provoked MVT event. Interval appendectomy was ultimately performed for three of four patients.

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