Catastrophic Gastroduodenal Artery Pseudoaneurysm Rupture During Endoscopic Necrosectomy in Severe Necrotizing Pancreatitis: A Rare Life-Threatening Complication.

Pseudoaneurysm formation is a rare but potentially fatal complication of necrotizing pancreatitis due to the risk of rupture. We report a 28-year-old man with walled-off pancreatic necrosis who developed catastrophic hemorrhage from a ruptured pseudoaneurysm during endoscopic ultrasound-guided necrosectomy, resulting in intraprocedural cardiac arrest. The patient required immediate cardiopulmonary resuscitation and emergent angiography, which identified the bleeding source and achieved hemostasis via coil embolization. He survived following prompt multidisciplinary intervention. This case highlights the unpredictable nature of vascular complications in necrotizing pancreatitis and the critical role of rapid multidisciplinary response in managing life-threatening hemorrhage.