To demonstrate the CT manifestations of gastric bare area involvement (GBAI) and left adrenal gland involvement (LAGI) in acute pancreatitis (AP) and evaluate their prognostic value. From January 2003 to December 2006, CT examinations of 116 patients with AP were retrospectively reviewed. There were 34 (29.3%) patients with GBAI showing haziness and streaky density or fluid collection in the gastric bare area, and 18 (15.5%) with LAGI showing deformity and hypoattenuation of left adrenal gland. The mean duration of hospital stay in patients with GBAI and LAGI was longer than that of patients without (P<0.001). The sensitivity and specificity of GBAI for predicting complications were 43.3% (0.31, 0.55) and 89.8% (0.81, 0.98), respectively; and 83.3% (0.36, 1.00) and 73.6% (0.65, 0.82) for predicting mortality. A patient with GBAI was 6.7 (2.4, 19.1) and 14.0 (1.6, 124.6) times more likely to have complications and die than was a patient without. The sensitivity and specificity of LAGI for predicting complications were 23.9% (0.14, 0.34) and 95.9% (0.86, 0.99), respectively, and 66.7% (0.22, 0.96) and 87.3% (0.81, 0.94) for predicting mortality. A patient with LAGI was 7.4 (1.6, 33.8) and 13.7 (2.3, 81.9) times more likely to have complications and die than was a patient without. Our results showed that GBAI and LAGI were characteristic CT findings in AP and could serve as useful prognostic indicators for this disease.