A 1.5-year-old male intact Black Leopard (Panthera pardus) was presented to the Exotic Animal Service at Cornell University Hospital for Animals as a referral for evaluation of chronic lethargy and chronic progressive vomiting of at least 12 months duration. Six weeks prior to presentation, the leopard’s vomiting acutely progressed to twice daily with notable ptyalism. The leopard was treated empirically with famotidine and fenbendazole without effect. Portioning out smaller and more frequent meals appeared to help, but the leopard continued to vomit at least once daily. The owner reported a normal appetite despite the chronic vomiting. On presentation the leopard was bright, alert, and responsive. The patient was sedated with ketamine and alfaxalone intramuscularly and was then induced for anesthesia with alfaxalone intravenously. He was maintained on isoflurane for general anesthesia. The patient’s vital parameters were within normal limits and point of care blood work did not reveal any significant clinical abnormalities. Thoracic and abdominal radiographs revealed a severe cranial gastric displacement, severe diffuse esophageal dilation, and non-specific liver changes. The differential diagnoses considered for the cranially displaced stomach included diaphragmatic eventration, hiatal hernia, and less likely para-esophageal intussusception or gastric-esophageal intussusception. The non-specific liver changes could be secondary to congestion (from caudal vena cava compression), or primary hepatopathy. A full body computed tomography scan was performed for teaching purposes and confirmed the radiographic findings. The patient was then taken to surgery where an exploratory laparotomy diagnosed a Type II paraesophageal hiatal hernia with concurrent diaphragmatic eventration. The precise etiology of the leopard’s conditions was unknown but was presumed to be congenital (vs acquired). A herniorrhaphy, phrenicoplasty, esophagopexy and left-sided gastropexy were performed and the leopard recovered from anesthesia without complications. Later that evening the leopard willingly ingested ground turkey meatballs containing post-operative oral medications: maropitant citrate, oral omeprazole, metoclopramide, and tramadol. The leopard rested comfortably overnight and the following morning was quiet and more alert than the previous evening. The leopard was discharged to the care of its owner in the afternoon with the same post-operative oral medications. Over the next week, the leopard continued to improve and did well eating soft foods and taking oral medications.