A case of a compound hiatal hernia in an asymptomatic patient who presented with complicated acute appendicitis and underwent emergency appendectomy. Although the stomach appeared fluid-filled, there was the noted absence of vomiting and epigastric pain which affirmed the CT suspicion of gastric rotation rather than a gastric volvulus.

The chest X-rays over 2 days demonstrated intermittent large and small bowel herniation through the large esophageal hiatal diaphragmatic defect giving rise to the unusual chest X-ray appearance.