Figure 24 - Obstruction and entrapment as a complication of type II paraesophageal hernia with an upside-down stomach.

The drawing on the left shows the hernia prior to obstruction with the EGJ still fixed at the hiatus. This drawing is analogous to the radiograph in Figure 10. With distention and filling of the fundus, it has the potential to form an organoaxial volvulus (Figure 11) and reherniate through the hiatus. Obstruction then develops at the duodenum and at the midportion of the stomach. Mortality of this condition is substantial. (Source: Hill,⁶⁹ with permission from Excerpta Medica, Inc.)