Pancreaticoduodenectomy is feasible in patients with complete situs inversus, ensuring oncologic principles are upheld.

• Complete R0 resection achieved in a 68-year-old with pancreatic adenocarcinoma.
• Complicated course included grade II adverse events with a 16-day hospital stay.

Surgeons should prioritize meticulous preoperative planning and adapt intraoperatively to unique anatomical variations.

• Final pathology revealed high-stage disease with 30 positive lymph nodes out of 33 examined.