Transhiatal intrathoracic herniation of the intestine after an Ivor Lewis esophagectomy is an unusual occurrence. This complication may present after any form of esophagectomy at varying intervals following primary surgery. Diagnosis is established on the basis of presenting symptoms and radiological features on computed tomography (CT scan). The authors herewith report this rare occurrence 42 months after an Ivor Lewis esophagectomy. The patient had herniation of the small bowel into the left pleural cavity , which was treated surgically through an entirely intra-abdominal approach and the defect in the diaphragm was bridged using a prosthetic polypropylene mesh.