Acute mesenteric ischemia in a child: A rare case report and diagnostic challenge in the emergency department.

Acute mesenteric ischemia (AMI) is a rare but life-threatening vascular emergency that typically affects elderly individuals with cardiovascular risk factors. We report a unique case of AMI in a previously healthy 15-year-old boy who presented with acute abdominal pain, hypotension, and metabolic acidosis. Point-of-care ultrasound revealed ascites without clear signs of ischemia, and ascitic fluid analysis was suggestive of secondary peritonitis. Due to clinical deterioration and rising lactate levels, the patient underwent emergency explorative laparotomy, which revealed extensive gangrenous bowel secondary to superior mesenteric vein thrombosis, necessitating resection of approximately 430 cm of small intestine. This case highlights the diagnostic challenges of AMI in adolescents, where classical risk factors and signs may be absent. Early clinical suspicion, bedside diagnostics, and prompt surgical intervention are vital to improving outcomes in such atypical presentations.