Abstract： Objective： To observe the clinical effect of enema with Rhei Radix et Rhizoma combined with external application at abdomen with Natrii Sulfas for severe acute pancreatitis (SAP) complicated with abdominal distension. Methods： A total of 80 cases of patients with SAP complicated with abdominal distension were selected and divided into the study group and the control group according to the random number table method，with 40 cases in each group. The control group was given symptomatic treatment with routine western medicine and nursing intervention，and the study group was additionally treated with enema with Rhei Radix et Rhizoma combined with external application at abdomen with Natrii Sulfas based on the treatment of the control group. Both groups were intervened for 7 days. The remission time of abdominal distension， the recovery time of bowel sounds， the first defecation time， heart rate (HR)， oxygenation index， Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Modified CT Severity Index (MCTSI) scores， intra- abdominal pressure (IAP)， gastric residual volume， fasting gastric antrum contraction frequency，bowel sound frequency，serum lipase (LPS) and pancreatic amylase (PAMY) levels， and the incidence of adverse reactions were compared between the two groups. Results： After intervention， the remission time of abdominal distension， the recovery time of bowel sounds， and the first defecation time in the study group were shorter than those in the control group (P＜0.05). The scores of HR，APACHEⅡ and MCTSI，IAP，gastric residual volume，serum LPS and PAMY levels in the two groups were lower than those before intervention (P＜0.05)， while HR， APACHE Ⅱ and MCTSI scores， IAP， gastric residual volume，and serum LPS and PAMY levels in the study group were lower than those in the control group (P＜0.05). The oxygenation indexes，fasting gastric antrum contraction frequency，and bowel sound frequency in the two groups were increased when compared with those before intervention (P＜ 0.05)， and the oxygenation index， fasting gastric antrum contraction frequency， and bowel sound frequency in the study group were higher than those in the control group (P＜0.05). During the treatment， there was no statistically significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusion： Enema with Rhei Radix et Rhizoma combined with external application at abdomen with Natrii Sulfas has a positive effect on the recovery of gastrointestinal tract function in patients with SAP complicated with abdominal distension，which can effectively relieve the clinical symptoms with good safety.