Extraorgan complications of acute destructive pancreatitis are registered in 60–95% of patients. Liver failure is regis-tered in one of the four patients with pancreatic necrosis. We analyzed the results of surgical treatment of 122patients with acute destructive pancreatitis. We studied clinical indicators of liver failure in 103(84.4%) patients with acute pancreatitis. The development of portal hypertension with decrease in hepatic volume perfusion is an important ele-ment in the pathogenesis of acute pancreatitis and associated liver function abnormalities. In patients with severe and moderate liver failure, the reduction of blood flow in portal vein was registered. It was caused by reduce of portal vein diameter and decrease in linear blood flow velocity. Destructive pancreatitis is accompanied by liver failure with hyperbilirubinemia, increased activity of cytolytic enzymes, incoordination in protein and carbohydrate metabolism as its common manifestations. An important factor in the pathogenesis of liver failure is a reduction of porto-hepatic hemodynamics and as a consequence – hepatic hypoperfusion.