Gastric volvulus in infants, children, and adolescents is a rare event. The purpose of this study is to examine this congenital abnormality and its consequences, using cases with significant adverse outcomes. We will specifically discuss issues of diagnosis and treatment of acute gastric volvulus in association with diaphragmatic anomalies. In addition, the different types of gastric volvulus are compared and contrasted, highlighting areas that may allow for early recognition and prevention of complications related to this foregut obstructive process. Three clinical cases are reviewed, all with significant morbidity and/or mortality. These cases are combined with larger case series to arrive at a list of relatively specific clinical and radiologic findings that can alert the clinician to this diagnosis and thus expedite the child's assessment and treatment, averting major complications.