2. The sac passed into the posterior mediastinum entirely to the right of the 3. The possibility of gastropexy proving a satisfactory procedure. In this case the obstructive symptoms were due to rotation of the greater curvature and pylorus through the sac into the mediastinum and not to the fact that the upper third of the stomach was situated permanently in the thorax.vertebral column.The specimen described is unusual in the large size of the hernial sac extending into the right pleural area. Operation became imperative at an early age on account of the severity of the symptoms caused by the herniation of a large section of the stomach. A radical cure of the hernia by the thoracic route did not seem justifiable in this infant. . It would, however, appear possible that if a fixation of the stomach had been carried out at the first operation the child might have survived. It seems likely that an effective fixation of the distal half of the stomach would prevent prolapse of sufficient of that viscus into the hernial sac to produce symptoms. I wish to thank Mr. C . Max