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Abstract Background Situs inversus totalis is a rare congenital condition where there is complete inversion of thoracic and abdominal organs. There is limited information on the laparoscopic treatment of rectal cancer in patients with situs inversus totalis accompanied by other underlying conditions. Case presentation We report the case of a 61-year-old Chinese male with rectal cancer accompanied by situs inversus totalis, malignant middle cerebral artery infarction, stenosis of the right internal carotid artery and anterior cerebral artery, and diabetes who underwent a successful laparoscopic radical resection of rectal cancer. We discuss the diagnosis, treatment, and considerations for patients with situs inversus totalis accompanied by other underlying conditions. We performed relevant inspections, organized multidisciplinary team discussions, and made sufficient perioperative preparations. The patient had no intraoperative complications and was successfully discharged from the hospital. Pathological stage was T3N0M0, and the patient did not develop tumor recurrence or metastasis in the 24-month follow-up period. Conclusions We conclude that patients with rectal cancer with situs inversus totalis, even when accompanied by underlying diseases, can undergo surgical treatment with adequate preparation, and surgical treatment is the most effective treatment method.