Chilaiditi's sign is a radiographic term used when the hepatic flexure of the colon is seen interposed between the liver and right hemidiaphragm. When symptomatic, this is Chilaiditi's syndrome. We report a case of Chilaiditi's syndrome associated with transverse colon volvulus. A 64-yr-old male presented with abdominal pain, vomiting, and constipation. Barium enema demonstrated complete colonic obstruction, leading to operative decompression and right hemicolectomy. This is the second case in the English literature of transverse colon volvulus associated with Chilaiditi's syndrome. Colonic elongation and laxity of colonic and hepatic suspensory ligaments are the principal predisposing factors to these two entities.