A 61-year-old Caucasian man with a history of BPH and gastroesophageal reflux disease, who has been in his usual state of health until 36 hours prior to presentation, developed epigastric pain characterized as dull, constant, non-radiating, aggravated by positional changes without any alleviating factors and associated with nausea. He denied any similar episode of abdominal pain in the past. On physical examination, our patient was febrile at 38.5°C and tachycardic; his abdomen was soft with epigastric and periumbilical tenderness and minimal guarding. He occasionally drank a bottle of beer every two to three weeks but denied drinking alcohol recently, had a remote smoking history, and denied any illicit drug use. His home medications included saw palmetto, which he had been taking for the past three years, lansoprazole and multivitamins. His BPH was initially treated with tamsulosin by his urologist, however he experienced dizziness with this medication and was unable to tolerate it. He was then prescribed saw palmetto, which offered relief for his BPH symptoms. Laboratory results upon admission revealed elevated lipase and amylase levels at 4406 units/L (reference range, RR 20-104 units/L) and > 3500 units/L (RR 5.6-51.3 units/L), respectively. Triglycerides were normal at 145 mg/dL (RR < 250 mg/dL); his alcohol level was less than 10 mg/dL (RR 0-80 mg/dL). Our patient's liver function tests were normal: aspartate transaminase 35 units/L (RR 8-20 units/L), alanine transaminase 33 units/L (RR 10-40 units/L), alkaline phosphatase 140 units/L (RR 27-100 units/L) and total bilirubin 0.6 mg/dL (RR < 20 mg/dL). Basic metabolic panels were also within normal limits. His calcium level was 9.3 mg/dL (RR 8.5 10.4 mg/dL). A complete blood count was unremarkable except for leukocytosis at 14.1 × 103cells/mm3. An abdominal ultrasound demonstrated a common bile duct, measuring 0.5 cm in diameter, without cholelithiasis. Computed tomography (CT) of his abdomen with contrast showed that his pancreatic tail was indistinct with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient was diagnosed with acute pancreatitis and treated with supportive care, which included intravenous fluids and pain management. Our patient's pain improved, his diet was slowly advanced, and home medications were resumed with the exception of saw palmetto. On the fourth day of hospitalization, his pancreatic enzymes were within normal limits; he was discharged home with a lipase of 32 units/L and advised to avoid taking saw palmetto.