Numerical simulations were performed to investigate pressure fluctuations in the S-shaped region of a pump-turbine model. Analyses focused on pressure fluctuations in the draft tube and in the gap between the guide vanes and runner. Calculations were made under six different operating conditions with a constant guide vane opening, and the best efficiency point, runaway point, and low-discharge point in the turbine brake zone were determined. The simulated results were compared with experimental measurements. In the draft tube, a twin vortex rope was observed. In the gap between the guide vanes and runner, a low frequency component was captured at both the runaway and low-discharge points in the turbine brake zone, which rotated at 65% of the runner frequency. This low frequency component was induced by the rotating stall phenomenon. At the runaway point, a single stall cell was found in the gap between the guide vanes and runner, while at the low-discharge point, four stall cells were observed.