Purpose: Acute pancreatitis can be complicated by development of pseudocysts in 5-16% of cases. While most pseudocysts resolve on their own, symptomatic or complicated pseudocysts require drainage. Uncomplicated spontaneous rupture of pancreatic pseudocysts into a surrounding hollow viscous is very rare. 82 year-old male presented to a primary hospital for management of ascending cholangitis secondary to impacted CBD stones; an ERCP with sphincterotomy was performed to remove the stones. The procedure was complicated by a severe bout of acute pancreatitis. Six weeks later, he presented with sudden nausea, non-bloody emesis, epigastric pain, fatigue, anorexia and a 30-lb weight loss. He remained afebrile and had epigastric and periumbilical tenderness on exam. His WBC was 14.7 x 103/uL (4.5-11 x 103/uL) with normal differential count. The liver enzymes, amylase, lipase, CEA and CA 19-9 were normal. An initial abdominal CT scan revealed a 7cm gastric mass invading the pancreas. EGD showed a moderate amount of purulent material flowing from an isolated area in the upper body/fundus of stomach along the greater curvature with extrinsic antral compression. The patient was started on IV antibiotics and transferred to our hospital for further management. A repeat CT scan, 9 days later, revealed small fluid collections involving the posterior greater and lesser curvature of the stomach including the antrum and duodenum. No gastric mass, pancreatic abscess, necrosis, or mass was seen. Repeat EGD with EUS revealed 2 isolated areas of intense erythema, one on the angulus and the other along the lesser curvature with a nipple and distorted antrum. Ultrasound examination showed diffuse stomach wall thickening with areas of mixed echo pattern and air suggestive of an abscess. The patient was discharged on antibiotics and a follow-up CT scan 2 weeks later showed near complete resolution of the fluid collections. At 6 months, the patient remains completely asymptomatic. The cardinal sign of a pancreatic-gastric fistula is sudden onset of vomiting followed by rapid recovery. Very few cases of uncomplicated spontaneous rupture of pseudocysts via a cystogastric fistula have been reported in the literature. These fistulas are usually associated with severe sepsis or hemorrhage. Our patient is unique because the pancreatic pseudocyst presumably ruptured into the gastric layers resulting in an intragastric abscess which subsequently ruptured spontaneously into the gastric lumen. This is only the 2nd reported case of an uncomplicated spontaneous intraluminal gastric abscess rupture secondary to a pancreatic pseudocyst.