Highlights We report the very first case Management of gastric perforation in situs inversus totalis in a 45-year-old adult. The symptoms of acute peritoneal syndrome have evolved about 48 h. The thoraco-abdomino-pelvic scan confirmed the diagnosis of gastric perforation and situs inversus totalis. The patient underwent laparotomy (suture of gasturic perforation, appendicectomy) with uneventful postoperative course.