There has been very considerable progress in our understanding of the pathogenesis, diagnosis, and management of necrotizing pancreatitis, especially the use of contrast-enhanced computed tomography (CT) scanning to identify and quantify pancreatic necrosis, and fine-needle aspiration (FNA) to detect secondary infection of the damaged tissues. There remains the challenge of preventing necrosis and infection, as well as the questions of when and how to intervene for these complications.