The patient, a 54-year-old female, was found to have pancreatic occupancy due to epigastric pain 18 years ago, so she underwent resection of the pancreatic head with preserved duodenum, jejuno-pancreatic body Roux-Y anastomosis, and T-tube drainage for common bile duct exploration, and the postoperative pathological findings were solid pseudopapillary tumor of the pancreas. After the operation, he had 3 times of chemotherapy and regular review of abdominal CT every 6 months, and no abnormality was found. Eleven years ago, the abdominal ultrasound revealed a pancreatic mass, and the abdominal CT showed a 3.5×5 cm irregular soft tissue mass in the head of the pancreas with poorly defined boundaries with surrounding tissues, which could be enhanced after enhancement. The pathology confirmed the recurrence of solid pseudopapillary tumor of the pancreas, which invaded the muscular layer of the duodenal wall up to the submucosa, and metastatic peri-small intestinal lymph nodes (1/4) were seen. The patient came to our hospital again after ultrasound examination 5 years ago and was found to have multiple occupying lesions in the liver. Enhanced CT suggested three occupying lesions in the liver, 8.3 × 6.6 cm and 7.9 × 6.5 cm in the right lobe and 4.1 × 2.2 cm in the left lobe, which were considered as possible multiple metastases in the liver. PET-CT showed that three intrahepatic masses with increased radioactivity (SUV: 3.2, 2.0, 2.8) were intrahepatic multiple metastases. The patient underwent resection of multiple hepatic masses in December 2011 and recovered well after surgery. The patient continued to have regular postoperative reviews and no clear evidence of recurrence was seen. One month ago, the MRI of the abdomen was repeated in our hospital, suggesting that a 6.3×4.1 cm mass with slightly low T1 and slightly high T2 signals was seen in the middle abdomen at the level of the lower pole of the right kidney, which was considered a possible tumor metastasis, and the enhanced CT of the abdomen also suggested the same conclusion. The two larger lesions were located in the pelvis.) The two larger lesions were located in the right intra-abdominal cavity and the right posterior pelvis. The patient was admitted to the ward and operated for the fourth time on January 27, 2015. Intraoperatively, intra-abdominal adhesions and their severity were found, with loss of normal anatomy, so the adhesions were carefully separated, the corresponding organs were freed, and all the metastases shown on PET and MRI were explored and found, and the lesions were removed one by one, including: an isolated mass (2×1.5 cm) in the omentum under the original incision; a mass-fused mass (6× 5 cm); a mass in the left extrahepatic lobe near the left abdominal wall (3 × 2 cm); a right retroperitoneal mass (2.5 × 2 cm); and a mass in the pelvic floor (utero-rectal fossa) (3.5 × 2.5 cm); the operation was very difficult. Afterwards, the whole abdomen was carefully explored and no other abnormalities were found, so the operation was closed and the operation went smoothly and the patient recovered well after the operation.