INTRODUCTION: Situs inversus totalis (SIT) is an uncommon congenital syndrome, 
which refers to a reversal mirror-image of the normal thoracoabdominal organs 
position. The coexistence of SIT and abdominal aortic aneurysm has been seldom 
previously reported.
PRESENTATION OF THE CASE: We report a case of a 69-year-old man with SIT and 
infrarenal abdominal aortic aneurysm (AAA) that underwent open repair with a 
straight graft through a minilaparatomy without evisceration.
DISCUSSION: There is no consensus on which should be the optimum approach in 
cases of open surgical repair of AAA due to the limited number of cases 
described. The fact of intestinal scrolling to the left abdomen, unlike usual, 
is due to the anatomical arrangement of the root of the mesentery which is 
directed obliquely from duodenojejunal on the left side of the vertebra L2 to 
the ileocecal junction and right sacroiliac joint.
CONCLUSION: A minilaparotomy without evisceration and with intestinal scrolling 
to left hemiabdomen, can be very useful and beneficial on those cases of 
congenital anatomical abnormalities that may add difficulty during the surgical 
procedure.