Gastric volvulus is a potentially lethal condition. We report a case of esophageal hiatal hernia with strangulation of the esophagus and stomach caused by gastric volvulus. A 79-year-old woman was admitted to our hospital in a state of shock, and investigations showed necrotic changes in most of her distal esophagus and gastric body. Thus, we performed an emergency total gastrectomy and transhiatal esophagectomy, followed 3 months later by successful reconstruction of the esophagus using the jejunum. Occasionally, a large hiatal hernia accompanies gastric volvulus; however, the extent of esophageal necrosis observed in this patient is very unusual. Although a large hiatal hernia is usually a chronic disorder, surgical treatment is recommended, considering the risk of serious complications.