Aim: Situs inversus totalis is an uncommon anatomic anomaly that complicates diagnosis and management of acute 
abdominal pain. Expedient diagnosis of common intra-peritoneal disease processes such as biliary colic, acute appendicitis and diverticulitis is often delayed as a result of that. 
Case presentation: We present a case of 37 years old male patient presented to our emergency room (ER) with a history of left acute lower abdominal pain and vomiting since 3 days with a known history of situs invertus totalis. Subsequent laboratory and imaging studies confirmed the diagnosis of situs inversus and acute left- sided appendicitis. The patient underwent an operative laparoscopy, which revealed appendicular and periappendicular adhesions involving the cecum. Where laparoscopic appendectomy were performed. 
Conclusion: The laparoscopic approach to an appendectomy is ideal in a patient with situs inversus.