According to the development of new diagnostic tools and methods, the chance of finding multiple primary cancer has increased. However, there has never been reported in the world four primary cancers in the abdominal cavity. We report a 58 years old female who had stomach cancer, gallbladder cancer, cholangiocarcinoma, and rectal cancer in the abdominal cavity simultaneously, and was done hepato-pancreato-duodenectomy and low anterior resection was performed.