Necrotizing acute pancreatitis is defined as necrosis of the adipose tissue, interstitial tissue and glandular tissue associated with areas of hemorrhage. Several causes are known predominantly biliary lithiasis and alcoholism. Severe consequences due to the release of pancreatic enzymes include activation of inflammation mediators which can lead to multiple organ failure. Although no therapy has been proven to be effective, progress in intensive care has helped reduce mortality. Rapid diagnosis and evaluation of the severity of illness with specific or general scores (Apache II score) are the keys to rapid management using therapies adapted to the degree of organ failure. Indication for surgery must be established in coordination with surgeons and depends both on the clinical course and computed tomography score.