Objectives and Importance: Mesenteric venous thrombosis is a very rare disorder during pregnancy. We report a 28-week pregnant woman who presented with acute abdominal pain that was proved to be due to mesenteric venous thrombosis. Clinical Presentation: A healthy, pregnant woman presented to surgical casualty with an 8-hour complaint of severe generalized abdominal pain. Clinical examination revealed a 28-week gravid uterus and a mildly distended and soft abdomen with absent bowel sounds. Sonographic findings were unremarkable. Intervention: Exploratory laparotomy revealed a gangrenous loop of the sigmoid colon, which was resected, and Hartmann’s procedure was performed. Histopathological examination of the resected bowel tissue confirmed the diagnosis of mesenteric venous thrombosis. The patient was thoroughly screened for the presence of an underlying hypercoagulable state such as a deficiency of protein C, protein S, antithrombin III, activated protein C resistance, lupus anticoagulant, factor V Leiden, and prothrombin gene mutation. No abnormalities were found. Conclusion: Exploratory laparotomy and histological examination of excised bowel tissue were used to confirm a diagnosis of mesenteric venous thrombosis in a 28-week pregnant woman. The clinicians and surgeons should be alerted to such a disease especially in the absence of a pre-existing hypercoagulable state. Exploratory laparotomy, which was diagnostic in this case, should not be delayed.

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