The case of an 80-year-old woman with an incarcerated paraesophageal hernia is presented. Among diaphragmatic hernias, the paraesophageal or type II hernia occurs with an incidence of 5%, sliding or type I hernia occurs with an incidence of 95%. Incarcerated paraesophageal hernia is a surgical emergency requiring rapid decompression and reduction to minimize catastropic consequences of hemorrhage, perforation, and visceral infarction. The clinical presentation and diagnostic workup of the patient with incarcerated type II diaphragmatic hernia are discussed.