Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.