The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Microvascular thromboses in HUS may involve intestine, pancreas, skeletal muscle, and heart. Microinfarcts in the pancreas may cause acute pancreatitis and rarely insulin-dependent diabetes mellitus. Acute pancreatitis is a relatively common complication of HUS in children, but rare (2%) in adults. We have experienced a 43 year-old woman with HUS complicating acute pancreatitis. She presented with hemolytic anemia, thrombocytopenia and acute renal failure. During hemodialysis, she complained of left side abdominal and back pain. On laboratory study, levels of serum amylase and lipase were elavated. The size and shape of pancreas was normal on abdominal ultrasonography and computed tomography. We present this case with a review of literature.(Korean J Med 59:663-667, 2000)