Post-esophagectomy hiatal hernia is an uncommon condition. Patients may present with small asymptomatic hiatal hernias, nonspecific chronic symptoms or even acute presentations with signs of intestinal obstruction and ischemia. In this case, a three-stage esophagectomy was performed in a female patient diagnosed with end-stage achalasia with subsequent development of hiatal hernia strangulation, for which damage control surgery was key for its management. The implication of damage control surgery in treating strangulated hiatal hernias is an uncommon but valid occurrence as an option for the surgical management within the clinical context of critically ill patients.