In a retrospective study, all cases of patients with acute pancreatitis admitted consecutively to the University Hospitals in Riyadh over the five-year period 1984-1988 were analyzed. There were a total of 104 attacks in 91 patients. Mean patient age was 42.4 years and the female to male ratio was 1.5:1. In 67%, gallstones were the associated cause; idiopathic acute pancreatitis was diagnosed in only 11.5%. Among the 50 (55%) Saudi nationals, two thirds were females and 76% had biliary pancreatitis. Using modified Glasgow severity prediction criteria, 21% of the attacks were designated as ''severe disease.'' Mortality in this series was 3.3%; all deaths occurred in the ''severe disease'' group and all had nonbiliary acute pancreatitis. Pseudocysts developed in six patients, including a pancreatic abscess in one. This study shows that acute pancreatitis is not a common medical emergency in Saudi Arabia and is predominantly biliary-associated, especially affecting females. The disease seems to follow a more benign course and has lower morbidity and mortality than that described from the West.