The mortality from acute pancreatitis at a single centre between 1967 and 1980 is described. The overall mortality was 11% and remained at a similar level throughout the review period during which annual admission rates doubled. Two main groups of mortality were identified. In those with primary pancreatico-biliary or gastric pathology, there were less associated medical conditions and death was commonly due to abscess formation. In those without such primary pathology pre-existing poor medical condition was common and contributed to death from milder forms of pancreatitis. Our findings suggest that a decrease in the mortality of acute pancreatitis is more likely to be achieved through improved medical management than by operative intervention.