Teaching case of advanced pancreatic adenocarcinoma, with a later presentation due to lack of obstruction of the common bile duct, and the patient will not present earlier with jaundice as with a typical pancreas head mass. This tumor has resulted in malignant obstruction of the large bowel and encasement of multiple adjacent structures, including the left renal hilum, resulting in collateralized left renal venous drainage with retroperitoneal and periureteric varices.