Volvulus in hiatus hernia

Paraesophageal hernias are associated with abnormal laxity of structures normally preventing displacement of the stomach, the gastrosplenic and gastrocolic ligaments. As the hernia enlarges, the greater curvature of the stomach rolls up into the thorax. Because the stomach is fixed at the gastroesophageal junction, the herniated stomach tends to rotate around its longitudinal axis, resulting in an organoaxial volvulus (top panels); infrequently, rotation occurs around the transverse axis resulting in a mesenteroaxial volvulus (bottom panels).