<i>Background/Aim:</i> The pancreas is an organ highly susceptible to ischemic damage. This discussion reviews the role of ischemia as an etiologic factor in acute pancreatitis. <i>Methods:</i> Literature review. <i>Results:</i> The susceptibility of the pancreas to ischemia/reperfusion injury has been demonstrated in experimental studies and in clinical settings such as cardiopulmonary bypass, hemorrhagic shock, and transplantation of the pancreas. Oxygen free radicals, activation of polymorphonuclear leukocytes, failure of microvascular perfusion, cellular acidosis, and disturbance of intracellular homeostasis appear to be important factors/mechanisms in the pathogenesis of ischemia/reperfusion-induced acute pancreatitis. In clinical practice, the diagnosis of ischemic pancreatitis is difficult and often delayed, especially during the postoperative period after cardiac or major vascular surgery. <i>Conclusions:</i> Ischemia appears to be one important factor in acute pancreatitis. The management of ischemic pancreatitis is similar to that of acute pancreatitis of any etiology.