Acute necrotizing pancreatitis complicated with gastroduodenal artery (GDA) pseudoaneurysm is a very rare (1.5% of all reported visceral arterial aneurysms), life-threatening emergency. Immediate treatment is required to prevent the very high mortality rate. A 77-year-old male with history of atrial fibrillation on apixaban presented with sudden onset diffuse acute abdominal pain, hematemesis, and maroon colored stools. Approximately six weeks prior, he diagnosed with necrotizing acute pancreatitis thought to be induced by dabigatran. At that time, he was discharged in stable condition. On arrival, patient was hypotensive and tachycardic. Patient's abdomen was tender and distended with decreased bowel sounds. His hemoglobin had dropped three grams compared to his last check three weeks ago, and his lactate was 6 mmol/L. CT abdomen with contrast showed significant worsening of underlying acute pancreatitis with necrosis and pseudocyst formation. He was started on intravenous antibiotics and fluids, and apixaban was held. The patient was transferred to the intensive care unit for further management. He remained tachycardic and hypotensive, requiring multiple packed red blood cell transfusions as his hemoglobin continued to drop. Intraabdominal bleeding was strongly suspected. Follow up CT abdomen with contrast showed worsening inflammation and necrosis of the pancreatic bed along with findings of a new 2.8 cm pseudoaneurysm of the GDA near the head of the pancreas. The patient underwent an angiogram, which showed enlarging GDA pseudoaneurysm. Interventional radiology subsequently placed a coil in the area. Signs of intraabdominal bleeding resolved and patient was discharged approximately two weeks later. GDA pseudoaneurysms that rupture have a 40% mortality rate. Pancreatitis is the most common risk factor for formation. Release of proteolytic enzymes combined with the host inflammatory reaction are thought to result in destruction of the vascular wall and localized bleeding which is contained by the surrounding tissues - also known as a pseudoaneurysm. Angiography serves both diagnostic and therapeutic purposes, as embolization proximal to the damaged portion of the artery prevents continued bleeding. Physicians should consider psuedoaneurysm as a cause of hemodynamic instability and acute blood loss anemia in patients with severe necrotizing pancreatitis. Emergent intervention, whether surgery or endovascularly, is needed to prevent death.FigureFigureFigure