Acute necrotizing pancreatitis remains a significant problem with significant morbidity and mortality. Keys to management include proper diagnosis, admission to the intensive care unit, aggressive resuscitation, and a multidisciplinary approach for management options. The care team should include a designated surgeon, gastroenterologists with expertise in endoscopic retrograde pancreaticography and stent placement, interventional radiologists, infectious disease physicians, nutritionists, respiratory therapists, and physical therapists. Antibiotics, nutritional support, and a dedicated team with expertise in managing these patients are keys to successful outcomes. This chapter provides current state-of-the-art management of necrotizing pancreatitis with particular emphasis on managing complex complications a surgeon may encounter.