The treatment of mild acute pancreatitis (AP) with fluid replacement and other conservative measures is adequate and sufficient in the majority of patients. The corner-stones of the treatment of patients with severe acute pancreatitis include early aggressive fluid resuscitation, intensive care with close monitoring and support of organ function, antibiotic prophylaxis, early supportive treatment of organ failure, and surgery in selected cases with infected pancreatic necrosis or deterioration of patient's condition in spite of maximal conservative therapy. Early endoscopic removal of common bile duct stones should be considered in cases with biliary AP. Altogether, increased accuracy in early diagnosis and development of intensive care have resulted in a significant decrease in mortality of patients with severe pancreatitis. In this paper, we review the current principles and methods of treatment in acute pancreatitis at Helsinki University Central Hospital.