Acute necrotizing pancreatitis represents a severe form of acute pancreatitis, characterized by pancreatic collections and necrosis of the pancreas and surrounding tissues. It is associated with higher rates of morbidity and mortality. Scrotal swelling is a rare complication of acute necrotizing pancreatitis due to the extension of pancreatic necrotic masses involving the inguinal canal and scrotum. We report a case of scrotal swelling as the first sign of unrecognized severe necrotizing pancreatitis with a fatal outcome.