Acute pancreatitis (AP) is a potentially fatal disease characterized by parenchymal cell inflammation and apoptosis, with severe local or systemic complications and high mortality rates. At present, the therapeutic aspects of AP are mainly anti-inflammatory and anti-apoptotic, but the mechanistic aspects of AP have not been fully elucidated, so identifying novel therapeutic targets and reliable biomarkers are needed. Exosomes is an extracellular vesicle (40mm-160mm) that includes not only lipids and proteins, but also nucleic acids, mainly tiny ribonucleic acid (miRNA) and messenger ribonucleic acid (mRNA), as well as some genomes and mitochondria. Exosomes can act as intercellular messengers by transferring signaling molecules (including proteins, miRNAs, and lipids) to their target cells. At present, the study of exosomes is gradually deepened, and some types of exosomes are constantly identified in living organisms, which are mainly involved in cell apoptosis, differentiation and inflammatory response. The different roles of exosomes lead to changes in the key physiological functions of AP. In this review, we summarize the various exosomes that currently interact closely with AP, as well as the possible directions of exosome-targeted therapy for the disease, which may help to develop potential biomarkers of the disease and new therapeutic targets to provide ideas for clinical and scientific researchers committed to studying AP.