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Situs inversus is a rare anomaly characterized by mirror-image location of of thoracic and abdominal organs. It can be associated with several other malformations including common mesentery which is a rare type of malrotation that develops as a result of the rotation of the intestines and with wandering spleen which is a rare anomaly characterized by the unusual position of the spleen in the abdomen and that most often occurs in children. We here report the case of a male patient aged 8 years diagnosed with these three entities. He was admitted with chronic abdominal pain. Ultrasound assessment was performed. Clinical examination showed sensitive pelvic mass. Ultrasound objectified abnormal position of the liver and spleen (the liver in the left hypochondrium and the spleen in the right hypochondrium) and an oval isoechogenic mass characterized by tissue structures within the echo image in the spleen, located in the supravesical fossa, lateralized to the right. CT scan confirmed that the liver occupied both hypochondria, with the hilus and gallbladder found on the midline; the splenic fossa was empty and the supra-vesical pelvic mass was homogeneous, isodense to splenic parenchyma and raised in the same way to the spleen (it was a floating spleen), its arterial vascular pedicle was directly connected to the abdominal aorta. Intestinal rotation abnormality suggesting common mesentery was also objectified.