An elderly woman was seen in the Gastroenterology Clinic to evaluate 6 months of weekly episodic, left-sided, postprandial abdominal pain with nausea. Episodes typically lasted 30 minutes. The pain did not occur with every meal, and improved after emesis. Between episodes she was asymptomatic. Examination and laboratory results were unremarkable. She underwent small-bowel follow-through, which captured an episode of stomach herniation with organoaxial volvulus (Figure A). The stomach herniated into the thorax and rotated along the cardiopyloric axis of the stomach (Figure B, dashed line). Note the reversal of the greater curvature (line A) and lesser curvature (line B). The patient was referred to a surgeon for potential endoscopic management of her hernia and gastropexy. Gastric volvulus is an abnormal stomach rotation that results from laxity of the surrounding ligaments. It may be categorized into primary or secondary, acute or chronic, or according to the axis of malrotation (organoaxial, mesenteroaxial, or combined). Unlike acute gastric volvulus, which results in the need for immediate medical attention from gastric ischemia, perforation, or complete gastric outlet obstruction, chronic volvulus can be difficult to diagnose because of the spontaneous resolution of gastric volvulus. Old age, hiatal hernia on endoscopy, or evidence of diaphragmatic defects in patients with chronic intermittent pain should point to gastric volvulus.