The authors present a group of 31 patients with severe acute pancreatitis (SAP) treated by early or late surgery and prophylactic, symptomatic and causal medicamentous therapy of a different extent. The diagnosis of SAP is based above all on examination by CT after administration of a contrast substance into the digestive tract and vascular system. Surgical intervention during the first 2-5 days reduces the mortality substantially. It involves above all removal of necrotic masses and administration of multiple drainage. Repeated rapid revisions of the affected area make open packing possible or the use of Ethizip. In non-surgical treatment administration of broad spectrum antibiotics, vitamins, scavengers of free oxygen radicals, antiphlogistic agents, corticoids, immunopromoting preparations, extensive symptomatic individual medication, large volumes of fluids and adequate parenteral nutrition predominate. Controlled ventilation and haemodialysis are in many patients an integral part of treatment. The mortality was about 42% when treatment was early and adequate. In patients where treatment started late and was inadequate, the mortality was as much as twice as high!