Pump as turbines (PATs) are widely applied for recovering the dissipated energy of high-pressure fluids in several hydraulic energy resources. When a centrifugal pump operates as turbine, the large axial vortex occurs usually within the impeller flow passages. In view of the structure and evolution of the vortex, and its effect on pressure fluctuation and energy conversion of the machine, a PAT with specific-speed 9.1 was analyzed based on detached eddy simulation (DES), and the results showed that vortices generated at the impeller inlet region, and the size and position of detected vortices, were fixed as the impeller rotated. However, the swirling strength of vortex cores changed periodically with double rotational frequency. The influence of vortices on pressure fluctuation of PAT was relatively obvious, deteriorating the operating stability of the machine evidently. In addition, the power loss near impeller inlet region was obviously heavy as the impact of large axial vortices, which was much more serious in low flow rate conditions. The results are helpful to realize the flow field of PAT and are instructive for blade optimization design.