Introduction: the identification of a 10 cm bezoar in a hiatal hernia is unusual. Hiatal hernias are usually asymptomatic. When signs of strangulation are present the prognosis is unlucky if urgent surgical intervention is not performed. Although sometimes the prognosis is bad because of the advanced state of gastric ischemia.
Case report: a 67-year-old female patient undergoing Nissen fundoplication with recurrence of hiatal hernia, volvulated and strangulated with giant bezoar inside the hhital hernia sac.
Discussion: despite of poor results, surgical treatment in these cases must be urgent.