A record review of 256 patients treated for pancreatic pseudocysts (PPC) found 26 in whom jaundice was a presenting feature. Sixteen of these patients had jaundice from hepatocellular causes. Ten patients (4%) had extrahepatic biliary obstruction from PPC. These patients were studied for treatment and outcome. Bilirubin in the 10 patients averaged 7.7 mg% (range 2.0–23.6 mg%). Alkaline phosphatase was elevated in each patient. Five patients had preoperative ERCP, which confirmed a PPC compressing the bile duct. The remaining patients had PPC and bile duct dilatation confirmed by ultrasonography or operation. Eight patients required operation to treat their cyst. Four of the 8 patients had biliary drainage concomitant with the treatment of their PPC, while the other 4 resolved the jaundice following drainage of the cyst alone. Cyst duodenostomy was the most frequently used surgical procedure and appears to be a logical choice when feasible. Biliary bypass is not invariably required to treat obstructing pseudocysts in the head of the pancreas, but evidence of free biliary flow should be obtained after drainage of the cyst to ensure that the jaundice will resolve.