Background: Gastric volvulus (GV) complicating hiatal hernia is rare. It may complicate Nissen fundoplication. It may present with vague symptoms that delay the diagnosis. The radiology and upper gastroscopy are very helpful in diagnosis. The incarcerated stomach is liable for strangulation and infarction so diagnosis and early surgical intervention is mandatory. Patients and methods: From July 2012 till January 2016, 12 patients with gastric volvulus complicating hiatal hernia underwent surgical management at Ain Shams University hospitals. Results: A total of 12 adult patients presented with gastric volvulus complicating hiatal hernia. Most of the patients had vague symptoms such as atypical gastric pain, fever, obstructive episodes and recurrent chest infection. Six patients had history of previous laparoscopic Nissen fundoplication. In all patient surgical procedures started laparoscopy and completed laparoscopy in 8 of them while converted to open surgery in 4 patients due to difficult in dissection. Conclusion: Gastric volvulus complicating hiatal hernia is rare and can present in a variety of ways and need a high index of suspicious for diagnosis and early surgical intervention. Keywords: gastric volvulus, hiatal hernia.