Abdominal pain is common chief complaint of the patients presenting to the emergeycy department(ED). Causes are multiple and diverse. Situs inversus is rare clinically and with left-sided appendicitis in these patients are even much less. We present a case of abdominal pain but with opposite location of appendix. A 24 years-old male patient came to our ED with complaint of periumbilical pain then shift to left lower quadrant (LLQ). There is no fever, no nausea or vomiting initially. 14,000 Seg 82 L 11 CRP 6.99. Plain abdomen X ray showed liver shadow in LUQ of abdomen, and stomach gas over RUQ of abdomen. Dextrocardia discovered in EKG. ED ultrasound also showed a tubular structure in LLQ of abdomen. Abdominal CT scan had arranged and showed right-sided location of stomach and spleen as well as left-sided location of liver consistent with situs inversus. A tubular structure with wall thickening and perifocal strandings consistent with appendicitis in left pelvic cavity. Emergent operation by surgeon showed a perforated appendix and lumen filled with feces. Since all the organs in situs inversus are all inverted with mirror image. ED ultrasound provide a effective and quick method of confidence in proving situs inversus clinically by showing liver over left side and spleen over right side. Further abdominal CT scan not only provides accurate diagnosis of the left-sided appendicitis but also is particularly useful in detecting associated rotational anomalies and related complications that require separate surgical correction.