Background: Acute pancreatitis is a common condition that is still associated with substantial morbidity and mortality rates. Management, outcome and recurren ce rate in acute pancreatitis in a clinical setting using a conservative managem ent approach are described. Methods: A total of 1376 consecutive cases represent ing 2211 hospitalizations due to acute pancreatitis treated at the Dept. of Surgery, Lund University Hospital, Lund, were reviewed retrospectively. Management, outcome and recurrence rate wer e recorded. Results: Incidence, including recurrences, was 300 per million per y ear; 21%of patients had recurrent (≥2) attacks. In relapsing disease, two-thi rds of patients had the first attack within 3 months. Mortality decreased over t he period studied, but overall it was 4.2%; mortality in relapsing attacks was 2.5%, related to multiple organ dysfunction syndrome(MODS) in 67%and occurring within the first week in 36%. Conclusions: Despite a conservative approach in the management of acute pancreatitis, mortality is still substantial, frequently occurs early after admission, is associated with MODS and is also seen in relap sing disease. Early cholecystectomy and bile duct clearance could decrease recur rent attacks of biliary pancreatitis. Background: Acute pancreatitis is a common condition that is still associated with substantial morbidity and mortality rates. Management: outcome and recurren ce rate in acute pancreatitis in a clinical setting using a conservative managem ent approach. Methods: A total of 1376 consecutive cases represent ing 2211 hospitalizations due to acute pancreatitis treated at the Dept. of Surgery, Lund University Hospital, Lund, were reviewed retrospectively. Management, outcome and recurrence rate wer e recorded. Results: Incidence, including recurrences, was 300 per million per y ear ; 21% of patients had recurrent (≥2) attacks. In relapsing disease, two-thi rds of patients had the first attack within 3 months. Mortality decreased over t period of study, but overall it was 4.2%; mortality in relapsing attacks was 2.5%, related to multiple organ dysfunction syndrome (MODS) in 67% and occurred within the first week in 36%. Conclusions: Despite a conservative approach in the manag ement of acute pancreatitis, mortality is still substantial, frequently occurs early after admission, is associated with MODS and is also seen in relap sing disease. Early cholecystectomy and bile duct clearance could decrease recur rent attacks of biliary pancreatitis.