Objective: To investigate the clinical and prognostic features of extrapancreatic necrosis (EPN) with or without pancreatic parenchyma necrosis (PPN) in acute pancreatitis (AP). Methods: A series of 118 cases of acute necrotizing pancreatitis were retrospectively analyzed from January 2013 to April 2018. According to CT imaging evaluation, 26 cases belong to isolated EPN without PPN (EPN group), and 92 cases belong to EPN combined with PPN (EPN + PPN group). The demographic characteristics, clinical and prognostic indicators were compared between the two groups. Results: The ratio of isolated EPN to necrotizing pancreatitis was 22.0% (26/118) in this series. There was no significant difference in age, gender, body mass index, etiological type, the incidence of transient organ failure and hospital stay between the EPN group and the EPN + PPN group (P>0.05). The APACHE II score at 24 h after admission (7.4±1.8 vs 8.5±1.7), CT severe index in the first week of onset (6.3±1.8 vs 7.5±2.2), ratio of primary infected necrosis (23.1% vs 48.9%), ratio of persistent organ failure (23.1% vs 47.8%), ratio of invasive intervention (26.9% vs 54.3%), ICU stay [(13.5±4.0) d vs (16.5±4.8 d)] and mortality (7.7% vs 26.1%) were significantly lower than those in EPN+PPN group (P<0.05). Conclusion: The clinical and prognostic features of EPN with or without PPN are different. The isolated EPN is mild, with fewer complications and better overall prognosis.