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Local complications typically refer to a variety of pancreatic and peripancreatic fluid collections that differ in both composition and time to development. Other local complications include gastric outlet dysfunction, splanchnic vein thrombosis, and colonic necrosis. Local complications should be suspected when there is persistence or recurrence of pain, organ dysfunction, fever, or leukocytosis. High‐resolution contrast‐enhanced computed tomography (CECT) is often the diagnostic test of choice. In the RAC, local complications do not by themselves constitute severe AP.

Among the types of (peri)pancreatic fluid collections, an important distinction is made between collections composed of fluid alone (acute peripancreatic fluid collection and pancreatic pseudocyst) and those that arise from necrosis and contain a solid component (acute necrotic collection and walled‐off necrosis). There is good interobserver agreement for the types of (peri)pancreatic fluid collections as defined by the RAC, particularly among experienced radiologists [22].

Table 3.2 Modified Marshall scoring system.

Source: Banks et al. [12]. © 2013 BMJ. Reproduced with permission of BMJ Publishing Group.

	Score
Organ system	0	1	2	3	4
Respiratory (PaO 2/FiO 2)	>400	301–400	201–300	101–200	<101
Renal (serum creatinine, mg/dl)	<1.4	1.4–1.8	1.9–3.6	3.6–4.9	>4.9
Renal (serum creatinine, μmol/l)	<134	134–169	170–310	311–439	>439
Cardiovascular (systolic blood pressure, mmHg)	>90	<90, fluid responsive	<90, not fluid responsive	<90, pH <7.3	<90, pH <7.2

A score ≥ 2 in any organ system defines the presence of organ failure in AP.