The article describes two cases of acute pancreatitis that occurred during therapeutic hypothermia in patients with severe brain injury. Therapeutic hypothermia is used to treat severe brain injury, lowering the temperature to 33–34°C and may improve neurological outcomes, but increases the risk of complications. In the first case, a 75-year-old woman with intracerebral hemorrhage was hypothermic to 34°C and developed acute pancreatitis the next day, which resolved after discontinuation of hypothermia. In the second case, a 62-year-old man with cerebral edema after thrombectomy underwent hypothermia to 33–34°C, and pancreatitis also appeared the next day, with improvement after rewarming. In both cases, common causes of pancreatitis have been ruled out, and the temporal context suggests an association with hypothermia. Acute pancreatitis during therapeutic hypothermia is extremely rare and its cause is multifactorial, involving hypothermia and stress reactions. Physicians should be alert to this complication to avoid delayed diagnosis and treatment.