Background <p>Pseudomyxoma peritonei is uncommon with a poorly understood pathogenesis. The standard treatment is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. However, radical surgical resection is not feasible for patients with extensive unresectable disease, which can lead to bowel obstruction, nutritional failure, and potentially death. In this report, we recommend classic multivisceral transplant as a potential curative treatment for advanced, unresectable pseudomyxoma peritonei, an application that, to our knowledge, has not been previously described.</p> Case presentation <p>We describe the case of a 34-year-old Iranian man with pseudomyxoma peritonei who presented with abdominal distension and weight loss. He initially underwent incomplete cytoreductive surgery due to extent of the disease. Subsequently, due to progressive disease and development of intestinal failure, he underwent a successful extraperitoneal radical exenteration and classic multivisceral transplant. No disease recurrence or significant postoperative complications were observed during 1.5 years of follow-up.</p> Conclusion <p>This case presentation demonstrates that total extraperitoneal radical exenteration followed by classic multivisceral transplant can be a viable and effective treatment option for patients with inoperable pseudomyxoma peritonei complicated by intestinal failure. It offers significant benefits to patients, improving both quality of life and life expectancy.</p>