Settled lesions of acute necrotizing hemorrhagic pancreatitis have been commonly reported. Early alterations remained unknown. In a retrospective pathological study of 20 total pancreatectomy specimens, early changes have been evidenced in "grossly unmodified" areas of pancreas: acinar cells homogenization, ductal dilatation with epithelial degeneration, diffuse interstitial edema and fibroblastic reaction, necrotic angeitis . These alterations were identical to the changes described in experimental studies.