When a radiopharmaceutial is seen in the intrathoracic cavity on Tc-99m iminodiacetic acid (IDA) cholescintigraphy, basically 2 abnormalities are seen: first the stomach, such as a hiatus hernia, which is abnormally located in the thoracic cavity, and duodenogastric reflux (bile) which is simultaneously seen. However, intrathoracic gastric activity seen on Tc-99m IDA hepatobiliary scintigraphy is rarely documented in a patient with hiatus hernia. This report is of an 83-year-old man with a large hiatus hernia with duodenogastric reflux who underwent hepatobiliary scintigraphy; the scans show an area of increased activity on the top of the liver due to duodenogastric reflux in a large hiatus hernia. This was confirmed by surgery: the patient successfully underwent laparoscopic paraesophageal hernia repair with Nessen fundoplication and laparoscopic cholecystectomy.