Objective To investigate the effect of postoperative peripancreatic filling of activated charcoal with cotton gauze pads in the small omental sac for the treatment of fulminant pancreatitis. Methods From April 2002 to July 2010, 25 cases of fulminant pancreatitis were admitted, including 17 males and 9 females, aged 13-74 years, average 40 years, 25 cases were cured and 4 cases died, with a cure rate of 84%. The cases were divided into 14 cases before April 2007 (cotton gauze pad group) and 11 cases after April 2007 (activated charcoal group), using April 2007 as the boundary. Results Two cases died within seven days after surgery in the cotton gauze pad group, with a mortality rate of 14.3% (2/14), and one case died after seven days, for a total of three cases, with a total mortality rate of 21.4% (3/14). In the activated carbon group, there was no death within seven days after surgery, and one case died after seven days, with a total mortality rate of 9% (1/11). The mortality rate within seven days and the total mortality rate were higher in the cotton gauze pad group than in the activated charcoal group. The APACHE II score, T, P and R were significantly better on the third and seventh postoperative days than on the first postoperative day in both groups (P<0.05), but activated charcoal had a better advantage than gauze pads (P<0.05); the mean hospitalization days in the cotton gauze pad group was 89.91±9.90 days and the hospitalization cost was 319,200±3.7 thousand yuan; the mean hospitalization days in the activated charcoal group was 79.00± 6.83 days and hospitalization cost of 27.38±2.80 thousand yuan. The data of both groups were higher in the cotton gauze pad group than in the activated charcoal group (P<0.05). Conclusion Activated charcoal has higher efficiency than cotton gauze pads in the adsorption and removal of inflammatory mediators and toxins in vivo during postoperative lavage of small omental sacs in fulminant pancreatitis, which can reduce postoperative mortality of patients. It shortens the length of hospital stay and reduces hospital costs.