The care of patients with severe acute pancreatitis is complex. Althou
gh numerous medical therapies have been proposed, few interventions ha
ve been shown to be of benefit in patients with severe disease. This r
eview summarizes the nonoperative management of patients dth acute pan
creatitis, including therapies shown to be of little value, the role o
f antibiotics in patients with acute pancreatitis, the importance of m
onitoring and supportive care, and the rationale of endoscopic and sur
gical intervention.