Gestational choriocarcinoma is a highly metastatic neoplasm derived from placental tissue, occurring in approximately 1:20,000 - 40,000 pregnancies. Although gestational choriocarcinoma may follow any gestational event, it most commonly follows molar pregnancies. We report a case of a 24-year-old Hispanic woman with persistent trophoblastic disease who, after failing to respond to chemotherapy, was found to have metastasis to the liver and pancreas. The patient underwent successful distal pancreatectomy and splenectomy to be followed by salvage chemotherapy. Strong risk factors for choriocarcinoma include previous molar pregnancy or spontaneous abortion and increased maternal age. Gestational choriocarcinoma is classically responsive to chemotherapy; surgical excision is reserved for acute emergencies and is an acceptable option for patients with persistent disease in need of palliative treatment and tissue diagnosis.