The incidence and significance of ecchymosis in 770 patients with acute pancreatitis is reported. The over-all incidence of 3 per cent is greater than generally appreciated. The development of this sign predicts the development of severe complications during the course of the disease and, in particular, there is an association with pseudocyst formation. However, the mortality of this group of patients is only 37 per cent which is in contrast to the views of many who believe that the development of Grey-Turner's sign or Cullen's sign, or both, predicts impending death.