Transdiaphragmatic intercostal hernia (TDIH) is a rare consequence from blunt chest-abdominal injury. The diagnosis of TDIH is often delayed. We report a patient who had a history of left-sided upper abdominal blunt injury 2 months before admission presented with a newly developed, massive pleural effusion and clinical manifestations of intestinal obstruction. A multidetector-row computed tomography confirmed the diagnosis of traumatic diaphragm rupture and TDIH. He underwent thoracotomy with reduction of herniated viscera and repair of the diaphragm and chest wall. He was discharged uneventfully and remained well on follow-up at 2 months.