A 10-day-old boy was referred for repair of left-side diaphragmatic hernia (Fig. 1). The following day he developed worsening respiratory distress. A follow-up chest radiograph showed a large, oval-shaped radiolucency suggesting massive intrathoracic gastric dilatation, presumably through the diaphragmatic hernia (Fig. 2). At surgery, an organoaxial gastric volvulus through a Bochdalek hernia was found. There were multiple decompressed bowel loops posterior to the gastric volvulus.

Fig. 1
figure 1

Chest radiograph, admission

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Fig. 2
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Chest radiograph, day 2

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Acute gastric volvulus associated with congenital diaphragmatic hernia is rare. It can be organoaxial, mesenteroaxial, or combined type [1]. It can be associated with Bochdalek, Morgagni, hiatal, or paraesophageal hernia. Sometimes, it is misdiagnosed as tension pneumothorax [2]. Congenital diaphragmatic hernia predisposes to gastric volvulus because the gastrophrenic and gastrosplenic ligaments are deficient or absent [1]. In gastric volvulus, the stomach is prone to ischemia and perforation, with increased morbidity and mortality.