A 64-year-old woman with a history of known pancreatic divisum, coronary artery disease, congestive heart failure, hypertension, type II diabetes mellitus, and opioid use disorder (on suboxone) presented to the emergency department with epigastric pain for the past few days. She was diagnosed with acute pancreatitis based on a lipase level of >600 U/L (normal is <50 U/L). She denied any history of heavy alcohol use. She reported history of smoking a pack of cigarettes per day for 20 years. She underwent a contrast CT scan of her abdomen that demonstrated interstitial pancreatitis with multiple obstructing stones in the proximal dorsal pancreatic duct with upstream dilation up to 7.8 mm. The gallbladder was distended without any evidence of cholelithiasis. She was treated with intravenous fluids and supportive care but continued to have ongoing symptoms with significant abdominal pain and nausea. Thus, the decision was made to pursue ERCP for pancreatic duct decompression (Video 1, available online at www.giejournal.org).