Objective: To assess the clinical efficacy of B ultrasound-guided percutaneous catheter drainage (PCD) for local complications of severe acute pancreatitis (SAP). Methods: The clinical data of 42 SAP patients with local complications undergoing B ultrasound-guided PCD from January 2006 to October 2009 in our hospital were retrospectively analyzed. Of the patients, 14 cases were complicated with acute fluid collection, 12 cases with sterile pancreatic necrosis, 9 cases with infected pancreatic necrosis, 4 cases with pancreatic abscess, 1 case with encysted infected necrosis and 2 cases with pancreatic pseudocysts. Microbiological examination was performed to determine whether the puncture fluid was associated with infection or not, and the clinical symptoms, drainage effect and imaging changes after PCD were observed. Results: Of the 42 patients, the 14 cases with acute fluid collection were all cured, but 2 of them developed peripancreatic infection and one case had an enterocutaneous fistula, but no death occurred; in the 12 cases with sterile pancreatic necrosis, 9 cases were cured (75%), 3 cases developed pancreatic infection and then underwent operation, 1 of whom died; in the 9 cases with infected pancreatic necrosis, 2 cases were cured and 4 cases underwent operation due to poor drainage, 2 of whom died and 3 declined treatment; the single case with encysted infected necrosis developed intracystic bleeding after PCD and died after emergency surgery; in the 4 cases of pancreatic abscess, 1 case was cured, 3 cases were converted to operation and no death occurred; the 2 cases with pancreatic pseudocysts were successfully drained and the catheters were removed 1 and 2 months later, respectively. Conclusion: B ultrasound-guided PCD is a safe and easily handled procedure, and it plays various roles in treating different SAP local complications. It avoids conventional surgical intervention for certain patients.