276 JOP. Journal of the Pancreas - http://www.serena.unina.it/index.php/jop - Vol. 15 No. 3 – May 2014. [ISSN 1590-8577] MULTIMEDIA ARTICLE JOP. J Pancreas (Online) 2014 May 27; 15(3):276-277. A 32 year old male patient diagnosed as alcohol related acute necrotising pancreatitis (ANP) 2 months ago, now presented with abdominal pain and early satiety. Contrast enhanced computerized tomography (CECT) showed 12 cm walled off pancreatic necrosis (WOPN) (Figure 1). Endoscopic ultrasound (EUS) revealed large WOPN and power doppler revealed vascularity in collection with pulsatile flow suggestive of blood leaking into collection (Figure 2). However, no abnormal vessel or pseudoaneurysm could be identified. CT angiography (CTA) also showed normal major abdominal arteries (Figure 3). Since patient was symptomatic, after informed consent EUS guided transmural drainage was attempted. Now there was no vascularity in collection and procedure was successfully accomplished. A 7 Fr nasocystic drain (NCD) was inserted and it drained purulent material. Patient had marked symptomatic relief but 6 hours later had severe pain and hematemesis with blood coming through NCD also. CTA revealed blood in WOPN but no abnormal bleeding vessel was identified (Figure 4). Digital An Unusual Complication of Acute Necrotising Pancreatitis Detected by Endoscopic Ultrasound Surinder Singh Rana, Vishal Sharma, Ravi Sharma, Deepak K Bhasin Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Figure 1. Large WOPN (arrow). Figure 2. EUS: Power Doppler showing vascularity in collection. The blood can be seen leaking into collection (arrow). Figure 3. CTA: normal major abdominal arteries (CTA: CT angiography; CA: Celiac axis; SMA: Superior Mesenteric Artery). Received April 22nd, 2014- Accepted April 25th, 2014 Key words Endosonography; Pancreatitis, Acute Necrotizing / complications Correspondence Surinder Singh Rana Department of Gastroenterolog, PGIMER, Chandigarh- 160 012, India Phone: +91-172-2749123; Fax: +91-172-2744401 E-mail: drsurinderrana@yahoo.co.in