The peculiarities in the surgical management of acute abdomen on two patients with situs inversus totalis were presented. The first patient was a 24 - year old male presenting with left lower quadrant abdominal pain. Appendiceal rupture occurred due to delay in diagnosis. The second patient was a 32 - year old female diagnosed to have calculous cholecystitis and situs inversus totalis who underwent laparoscopic cholecystectomy. This is the first reported case of laparoscopic cholecystectomy in a situs inversus totalis patient in the Philippines.