An 84-year-old man with pancreatic cancer and a pancreatolith in the pancreatic head presented with high fever and hypotension during follow-up after placement of a biliary fully covered self-expandable metal stent (FCSEMS). Blood tests revealed elevated inflammatory markers, with normal pancreatic enzyme levels. Computed tomography demonstrated worsening pancreatic duct dilation with minimal parenchymal edema, suggesting AOSPD (acute obstructive suppurative pancreatic ductitis). Urgent pancreatic duct drainage (PD) was necessary. We opted for transmural Endoscopic Ultrasound-guided Pancreatic Drainage (EUS-PD) instead of transpapillary PD. EUS-PD was preferred due to anticipated pancreatic ductal stenosis caused by the cancer and pancreatolith, and FCSEMS was placed in the bile duct. EUS allowed for visualization of the pancreatic duct from the stomach and duodenum, and endoscopic manipulation within the duodenum was considered more stable. EUS-PD was performed using a 7 Fr plastic stent after duodenal puncture with a 19 G needle. Yellowish-white pancreatic juice was obtained, and Enterobacter cloacae was cultured. Following EUS-PD, inflammation and fever resolved promptly.