Situs inversus totalis is a rare congenital anomaly in which position of the 
heart and all abdominal viscera is reversed. Situs abnormalities usually go 
unnoticed but may be recognized by radiography or ultrasonography as an 
incidental finding or during evaluation for congenital heart diseases. We 
present such an extremely rare and to the best of our knowledge the third 
reported case of an injured spleen in the right hypochondrium, following 
seemingly trivial blunt trauma in a patient with situs inversus totalis who 
underwent splenectomy. The presence of associated congenital heart defects, 
visceral anatomical variations and mirror imaging makes the anaesthetic 
management as well as the surgical exercise a challenging one in such cases.