Objective To investigate the clinical value of multi-slice spiral CT (MSCT) in the diagnosis of abdominal wall involvement in acute pancreatitis. Methods A total of 25 cases of acute pancreatitis in the hospital from January 2014 to May 2017 were included in the study. All patients were given MSCT examination after onset, the performance of abdominal wall involvement with MSCT was observed, Balthazar CT classification, acute pancreatitis severity CT (CTSI) score and clinical score were implemented. The correlations between the abdominal wall involvement showed by CT and CT evaluation, clinical evaluation were compared. Results Of the 25 patients with acute pancreatitis, the incidence of CT changes in the abdominal wall was 48.00%. The main manifestation was that the cord-like shadow of the abdominal wall paralleled extension with the body wall, the boundary of the abdominal wall and the muscle gap was unclear or even disappeared, the muscle fat of the abdominal wall was significantly thickened and swollen. Correlation analysis showed that abdominal wall changes in patients with acute pancreatitis were positively correlated with Balthazar classification, CTSI score and clinical classification (r=0.521, r=0.448, r=0.396, all P<0.05). Conclusion The abdominal wall involvement indicated by CT can be used as a reference index to evaluate the severity of pancreatitis, but it is still suitable for clinical evaluation in combination with other symptoms.