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Figure 1 An 83−year−old woman with a known history of hiatus hernia was admitted to our unit complaining of retrosternal discomfort and repeated vomiting. A chest radiograph on admission revealed a distended precordial gas− tric bubble, suggestive of intrathoracic gastric herniation. Initial upper endoscopy revealed bi− zarre gastric anatomy and it was not possible to negotiate the pyloric channel. Barium meal (a) and computed tomography (b) confirmed the diagnosis of paraesophageal hernia with intra− thoracic upside−down stomach.

Endoscopic Reduction of a Gastric Volvulus Associated with a Paraesophageal Hernia