Background: Splenic artery pseudoaneurysms (SAPs) are a rare complication of chronic pancreatitis. Fewer than 50 cases of giant SAPs (> 50mm) are reported, with varying approaches to treatment. SAPs can lead to haemosuccus pancreaticus (HP), posing a diagnostic challenge due to the location and intermittent nature of symptoms. Case presentation: A woman in her early 50s presented anaemic (Hb 59) with two weeks of intermittent haematemesis, melaena, and pre-syncope. Endoscopic examinations found no cause. Three months later she re-presented with the same symptoms and a subsequent Hb of 41. Computed tomography (CT) angiography found no acute bleed, however noted an incidental pancreatic lesion of undetermined significance. Magnetic resonance cholangiopancreatography (MRCP) was consistent with focal necrotising pancreatitis. Interval CT four-days later identified a 6mm SAP within a pancreatic collection, raising the likelihood of HP causing the patient’s gastrointestinal symptoms and anaemia. Splenic artery coil embolisation was successfully performed. Over the next 12 months, repeat CTs showed a gradual increase in the pancreatic collection width up to 67mm. 18 months after her initial presentation, the patient was admitted for an elective operation and found to have a Hb of 56. CT angiography favoured an aneurysm from the gastroepiploic branch, with percutaneous and angiographic embolisation deemed technically not feasible. The decision was made to perform an open distal pancreatectomy and splenectomy, which was successful. Histopathology reported a pseudoaneurysm communicating with a cystic structure which extended 55mm. Conclusion: In discrete clinical scenarios, surgical resection is possible for vascular complications.