Aim: To classify systemic pathomorphologic changes in severe acute pancreatitis (SAP) and to identify histologic features associated with abdominal compartment syndrome (ACS). Materials and Methods: The retrospective cohort examination of 53 patients with SAP, who died due to progressive organ failure. Microscopic specimens of the heart, lungs, liver, kidneys and intestines have been reviewed, divided by the proposed four levels of pathological changes and comparable between the two groups, depending on the presence of AСS (25 and 28 patients). Results: When comparing in two groups the levels of lesions of each studied organ, according to given levels of change, a statistically significant difference between groups in the level of kidney and intestine lesions (P <0.05, Mann-Whitney U-Test) was obtained. The changes in moderate and severe levels were significantly dominating in the microscopic specimens of the kidneys and intestines of group A compared to group B (p <0.001). Conclusions: Histopathological changes in the examined organs of patients who died from severe acute pancreatitis complicated by abdominal compartment syndrome were characterized by more pronounced ischemic and inflammatory damage in the kidneys and intestines. The variability of extrapancreatic pathological changes in SAP patients depended on intra-abdominal pressure levels. Monitoring and timely correction of intra-abdominal hypertension aimed at preventing ACS in SAP patients may influence disease progression and treatment outcomes.