Situs inversus totalis is a rare autosomal recessive disorder characterized by transposition of the intra-abdominal as well as the intrathoracic viscera. We present the case of a 45-year-old Pakistani lady who had choledochal cyst with cholelithiasis in tandem with situs inversus totalis. We were faced with dilemmas both diagnostic and management during the course of her care. We share our experience with emphasis on both ultrasonologist as well as surgical team members to be mindful of the possibility of an underlying choledochal cyst when they are dealing with symptomatic gall stone disease in such patients. This will ensure appropriate surgical planning and avert the avoidable dilemmas intra-operatively.