acute pancreatitis is characterized by the onset of parenchymal and peripancreatic fat necrosis with associated inflammation in a previously healthy individual .
acute pancreatitis should be suspected in patients with acute severe abdominal pain and can be classified based on severity .
the atlanta classification divides acute pancreatitis into two groups : interstitial edematous acute pancreatitis and necrotizing acute pancreatitis . the first category is characterized by pancreatic parenchymal and peripancreatic inflammation without necrosis , while the latter category involves inflammation and some degree of necrosis .
the diagnosis of drug - induced acute pancreatitis first requires a diagnosis of acute pancreatitis .
elevations in several biomarkers are indicative of pancreatitis , including serum lipase and amylase that are secreted in bulk by pancreatic acinar cells and thus are most commonly measured .
other laboratory tests with diagnostic implications include serum trypsinogen , pancreatic proteases , c - reactive protein , interleukin-6 and interleukin-8 .
the next step in diagnosing drug - induced pancreatitis requires ruling out more common etiologies such as gallstone pancreatitis and ethanol - induced acute pancreatitis .
the history should focus on previous symptoms and any record of gallstones , ethanol abuse , hypercalcemia , hypertriglyceridemia and trauma .
serum amylase , lipase , triglyceride level , calcium level and liver function tests should be ordered .
abdominal and endoscopic ultrasounds should be performed to evaluate for gallstones and other obstructive possibilities such as tumors of the pancreas head .
orlistat is a pancreatic lipase inhibitor which is used to treat obesity . due to the increasing prevalence of obesity
the indications of orlistat are body mass index ( bmi ) > 30 without any risk factors or bmi > 27 with additional risk factors such as hypertension , hyperlipidemia or diabetes .
orlistat has been reported to be associated with adverse events such as hepatic cholestasis , subacute hepatic failure and hepatic necrosis .
however , placebo - controlled studies have shown no relationship with acute pancreatitis [ 4 , 5 , 6 , 7 , 8 , 9 ] .
only four cases of acute pancreatitis associated with orlistat have been reported in the literature , and one of those cases did not demonstrate an increase in serum amylase [ 10 , 11 , 12 ] .
we report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging ; in addition , the case had significantly elevated serum amylase levels .
a 54-year - old male with a history of hypertension was admitted to the emergency department with complaints of abdominal pain , nausea and vomiting lasting for 24 h. it was learned from his medical history that he had been using irbesartan for 7 years , and in addition to this drug , orlistat treatment had been started 7 days before for obesity . the obese - looking patient had a height of 1.72 m , a weight of 94 kg and a bmi of 31 .
he was afebrile with a blood pressure of 140/90 mm hg and a pulse of 102 bpm .
the results were : white blood cells 12,600/l , serum amylase 2,409 u / l , c - reactive protein 136 mg / l and lactate dehydrogenase 835 u / l .
abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas ( fig .
on the third day after admission , abdominal pain , nausea and vomiting were improved .
serum amylase levels were normal and the patient was told to take specific measures addressed to his obesity .
alcohol use and gallstones are responsible for the development of more than 80% of acute pancreatitis cases .
drug - induced acute pancreatitis has a good prognosis and can be diagnosed by exclusion .
absence of gallstones , lack of a history of alcohol use with normal serum lipid and calcium levels and history of a recently started new medication support the diagnosis [ 13 , 14 ] .
orlistat blocks intestinal fat absorption by inhibiting gastric and pancreatic lipase and thus can cause symptoms such as rectal pain , oily feces , frequent defecation , nausea and vomiting .
all these lead to a modification of the patient 's behavior and eating habits to avoid eating fat , with the patient consequently losing weight .
orlistat is metabolized in the gastrointestinal tract and its direct destructive effect is shown in intestinal villi of animal models .
however , the mechanism in the development of acute pancreatitis is not known ; a possible mechanism may be direct toxicity or hypersensitivity such as in other drug - induced acute pancreatitis .
we report a case of drug - induced acute pancreatitis about 1 week after initiation of orlistat .
the patient in our case had a very high serum amylase level , although imaging studies showed that he was in a very early stage of edematous pancreatitis .
serum amylase levels were found to be normal in a previously reported case of acute pancreatitis associated with orlistat .
therefore , acute pancreatitis must be kept in mind when faced with newly developed abdominal pain in patients under orlistat treatment . in addition , imaging techniques ( such as hepatobiliary ultrasound and abdominal computed tomography ) should be requested .
more attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis ( alcohol use , height , serum calcium and lipid levels ) .
 orlistat is a pancreatic lipase inhibitor which is used to treat obesity . due to the increasing prevalence of obesity 
 , orlistat use is thought to rise progressively . 
 we report an interesting case caused by orlistat use caught in the early stages of acute pancreatitis through imaging ; in addition , the case had significantly elevated serum amylase levels . a 54-year - old male who had 
 a history of orlistat treatment started 7 days before was admitted to the emergency department with complaints of abdominal pain , nausea and vomiting lasting for 24 h. abdominal computed tomography revealed peripancreatic fat tissue edema and a heterogeneous appearance of the pancreas . 
 based on these findings , it was concluded that edematous pancreatitis was in its initial stage . 
 orlistat is a drug that is increasingly widespread use due to obesity . 
 more attention must be paid when planning to prescribe orlistat to patients if there are risk factors for acute pancreatitis ( alcohol use , height , serum calcium and lipid levels ) . 
Introduction
Case Report
Discussion
Conclusion
Disclosure Statement