Situs inversus totalis is a rare anomaly in adult. This entity is important clinically because of the possibility of misdiagnosis that could ensue from the abnormally rotated viscera hence; diagnostic conundrum in some situations. A middle-aged man presented with features consistent with large bowel obstruction. Radiological investigations were in keeping with sigmoid volvulus. Patient had laparotomy with finding of mal-rotated abdominal viscera, and had volvulus treated accordingly. The occurrence of such a rare pathology should be borne in mind. Patient and relatives should also be well informed about this peculiarity.