Situs inversus is a rare congenital anomaly where the intra-abdominal viscus are reversed or mirrored from their normal position. When associated with dextrocardia it is termed as situs inversus totalis. Though patients are asymptomatic, when presented with any pathology, the transpositioned viscus poses diagnostic difficulty, sometimes catastrophe. First reported in 1986, we in this article perhaps are reporting the third case of situs inversus totalis that presented with peptic perforation.