Four cases of pancreatitis with pseudocysts and massive ascites are reported. The presence of massive ascites created great diagnostic difficulties which were solved only by measurement of the ascitic fluid amylase concentration and by peritoneoscopy. The possibility of pancreatitis as a cause of massive ascites should be kept in mind, particularly in chronic alcoholics. In the differential diagnosis, abdominal paracentesis and peritoneoscopy are very helpful. © 1962 Hoeber Medical Division of Harper & Row, Publishers.