Acute pancreatitis ranges from mild to severe necrotizing form complicated by multiorgan failure with high mortality rate. It has different causes, not entirely clear pathogenesis and unpredictable and variable course. Therapeutic measures are limited. The mainstay of therapy is supportive intensive care, prevention of sepsis and multiple organ failure and identification and treatment of infected pancreatic necrosis. Surgical approach is justified in verified infected necrosis. In case of sterile pancreatic necrosis complicated by organ failures is the role of surgical intervention debatable.