An 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.