Purpose With modern imaging techniques, multidisciplinary management, and advances in supportive care, what are the indications for surgery in children with pancreatitis and have outcomes improved?Methods During a 12 year period, 62 children [31 girls, median age 12.0 (2.3 –16.9) years] with pancreatitis were managed in a single centre. All were investigated using a combination of ultrasound, ERCP, MRCP, and CT. Management comprised supportive care and treatment of any primary pathology. Severe acute pancreatitis (pancreatic necrosis, pseudocyst/abscess, and/or organ failure) was managed with broad spectrum intravenous antibiotics, H2 antagonists, prophylactic antifungal agents, and early parenteral nutrition followed by naso‐jejunal feeding.Results 51 children had acute pancreatitis, 14 (27%) of whom had severe disease. The leading causes were trauma (12), pancreaticobiliary malunion (6), gallstones (5), drug‐induced (4) and viral (4). In 10 patients no cause was found. Twenty four (47%) of these 51 children required surgery (20) and/or interventional procedures (4) to treat primary pathology (13) or pseudocysts (11) with resolution of pancreatitis in all. Eleven children had c
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