Changes in lifestyle have led to variation in the etiologies of acute pancreatitis in different areas of Taiwan. This study investigated the etiologies and factors associated with severity and recurrence of acute pancreatitis in southern Taiwan. Methods: Eighty acute pancreatitis patients (M/F: 64/16), including 53 (66.2%) with alcohol abuse, 16 (20%) with biliary disease, five (6.3%) with hyperlipidemia, and six (7.5%) with other risk factors, etiologies or idiopathic disease, were included. The mean follow-up period was 20 months. Contrast-enhanced computed tomography (CT) was used to assess the severity of acute pancreatitis. Results: Biliary pancreatitis was significantly associated with females while alcoholic pancreatitis occurred predominantly in males. Univariate analysis showed that male gender, alcoholic pancreatitis, and elevated serum triglyceride (>170 mg/dL) were significantly associated with severe acute pancreatitis. Multivariate logistic regression analysis revealed that male gender and abnormal serum triglyceride were independent risk factors for severity. Alcohol abuse was an independent risk factor for recurrent pancreatitis. Conclusion: Alcoholic pancreatitis was the major etiology of acute pancreatitis in southern Taiwan, exhibiting a strong male predominance and higher risk of severe CT grading. Abnormal serum triglyceride was independently associated with the severity of acute pancreatitis. Alcoholic pancreatitis had a higher risk of recurrence than other etiologies.