Pancreatitis associated with gross retroperitoneal or intraperitoneal hemorrhage occurred in 51 patients treated during a 20-year period. No patient treated non-operatively survived, while among 21 patients treated operatively, 9 or 43% survived. Operations performed on the survivors included drainage only, cholecystostomy, or merely exploratory laparotomy. Operation is recommended when complications occur and there is evidence of gross hemorrhage in patients with pancreatitis.