BACKGROUND: Nicotine causes pathological changes in the exocrine function of the pancreas. Although most cases of acute pancreatitis are caused by cholelithiasis or alcohol misuse, a significant percentage of patient have an idiopathic etiology. The knowledge that smoking tobacco is a major risk factor for developing pancreatitis would allow high-risk patient to take more preventive measures and could result in new intervention strategies.
CASE REPORT: In this case report, we discuss the case of a 24-year-old previously healthy male, who presented for 1-day history of epigastric pain, and was shown to have an elevated lipase consistent with acute pancreatitis. Despite an ultrasound showing hepatic steatosis and no evidence of cholelithiasis, a magnetic resonance cholangiopancreatography was done, in addition to a complete biochemical workup for other etiologies, all revealing completely normal results. The only reported exposure by the patient was heavy smoking in a short period of time, after which he developed his symptoms. The patient was discharged on the third day after presentation on symptomatic treatment with near total resolution of his symptoms and decreasing lipase.
CONCLUSIONS: The significance of this case is the linking of smoking, especially heavy use, with the development of acute pancreatitis, since smoking cigarettes is very common among all age groups. Also, it sheds light on the presentation of acute pancreatitis as abdominal pain only without accompanying symptoms like nausea or vomiting.

Keywords: Abdominal Pain, Pancreatitis, Smoking