Critical acute pancreatitis (CAP) is a type of acute pancreatitis (AP) characterized by the concurrence of both persistent organ failure and infected pancreatic necrosis. Its proportion in AP is relatively low. However, it is always complicated with extremely adverse clinical outcomes and high risk of mortality and morbidity. CAP has been supposed to be the most ominous severity category of AP. Due to few clinical studies focusing on CAP worldwide, the knowledge and clinical experience of CAP are still insufficient. Through literature review and summary of the practical experience, the authors interpret and discuss the progress of CAP, to attract further attention of the pancreatic surgeons, continuously improve the diagnosis and treatment measures and reduce the mortality rate of CAP.