Hiatal hernias are commonly encountered in elderly patients, predisposing patients to the common condition of gastroesophageal reflux disease (GERD). Depending on the size of the hernia, different complications can arise. Large hernias can lead to development of gastric volvulus, obstruction, strangulation, and perforation. Therefore, management of large hiatal hernias is crucial to avoid such complications. In this paper, we describe a patient who presented with acute gastric volvulus secondary to a large hiatal hernia. She improved with conservative management and subsequently underwent successful repair of the hernia. We emphasized the importance of identifying gastric volvulus among its vague presentation for prompt management.