56 year AAM with history of chronic pancreatitis presented with 7 days of abdominal pain and 2 days of nausea and vomiting. Abdominal pain was gradual in onset, worse on day of presentation, periumblical in location, radiating to the back. Nausea and vomiting were aggravated by eating, no hemetemesis or melena. ROS + for chills. PMH chronic pancreatitis 5 yrs, ETOH related, CAD, HTN, PVD and aortic aneurysm (4 cm) known for 1 yr. Smoker 30 pack yr, ETOH-quit 18 months ago no IVDA. Medications-aspirin, Lopressor, Viokase, Lipitor, Pepcid. Physical examination-lethargic, afebrile, H. R 98/min, regular, B. P 114/58, no tilt R. R 14/min, Sa O2 97% R.A. CVS-normal, Chest clear, Abdomen soft, not distended, mild tenderness umblical region, no guarding or rebound, BS normal, palpable aorta, Rectal-heme negative. Labs-HB 12. 1gm, WBC 10,600/cumm, platelets 415,000. Na 136 K 4.4 Cl102, Co2 16 BUN83 Creatinine 3.2 increased from 1.7 6 months ago. Amylase 46, Lipase 27 WNL. Abdominal Xray nonspecific gas pattern. Initially was managed conservatively as acute on chronic pancreatitis with intravenous fluids, NPO and pain management. His renal function improved by day 2 with no improvement in his pain. On day 2 he underwent CT scan of the abdomen without contrast shown below which revealed soft tissue attenuation below the level of duodenum abutting the aortic aneurysm below the renal arteries highly suspicious for leaking aneurysm. [figure 1] A doppler ultrasound confirmed an increase in the size of the aneurysm by 1.5 cmFigureThe patient was taken to surgery revealing a contained rupture of the aortic aneurysm which was consistent with an inflamed aneurysm, Peri-aortic fluid grew Staph aureus. The patient received axillo-bifemoral bypass graft and 4 weeks of I. V antibiotics and is currently doing well 6 months post procedure. Final diagnosis: contained rupture of mycotic abdominal aortic aneurysm. Discussion: Mycotic aortic aneurysm is uncommon and without surgical treatment can be fatal. Fever, pain and palpable mass in the region of the aorta should raise a high index of suspicion even when co-morbid conditions like chronic pancreatitis are present. Early imaging is essential to diagnosis and treatment.