Undifferentiated abdominal pain accounts for a significant proportion of emergency presentations and often presents as a diagnostic dilemma. Renal vein thrombosis (RVT) has many aetiologies including nephrotic syndrome, malignancy, trauma, infection and hypercoagulable states. RVT should be considered in cases of persistent abdominal pain where other, more common, pathologies have been excluded. We present the case of a 42-year-old male with a delayed diagnosis of bilateral RVT after presenting with multiple episodes of intractable abdominal pain and adverse sequelae of this condition. This case report aims to emphasize the importance of prompt RVT recognition and the utility of bedside emergency department (ED) investigations, which can guide initial differential diagnoses of abdominal pain, reduce the delay in diagnosis as well as limit unnecessary investigations.