Background: Recurrent pancreatic cancer may represent a true local recurrence or a second intrapancreatic primary. Resection of recurrent pancreatic cancer is uncommon. Case Presentation: A 68-year-old woman underwent a distal pancreatectomy/splenectomy for pancreatic adenocarcinoma after presenting with acute pancreatitis. She received 6 months of adjuvant gemcitabine. Nearly 5 years later, she presented with acute pancreatitis. Endoscopic ultrasonography suggested malignant degeneration of an uncinate intraductal papillary mucinous neoplasm (IPMN), but the cytology was negative. She subsequently underwent a completion pancreaticoduodenectomy for what proved to be a second pancreatic adenocarcinoma. Conclusion: Although uncommon, repeat resection for a second pancreatic cancer may be appropriate in select patients. Careful attention to the remnant pancreas must be maintained on surveillance imaging.