Pancreaticopericardial fistula is an extremely rare complication of chronic pancreatitis and is virtually unheard of in the setting of acute pancreatitis. A 67-year-old male presented with acute pancreatitis complicated by pancreaticopericardial fistulization. The patient's initial presentation was consistent with tamponade physiology. Computed tomography demonstrated a gas-containing pericardial fluid llection extending into the anterior upper abdomen and ill-defined fluid collections within the pancreas representing necrosis with probable infection. Surgical exploration of the window revealed a pancreatic pericardial fistula and an infected window. The patient ultimately passed away from septic shock. We present this rare complication of pancreatitis and review the relevant literature.