The best tool to guide the clinician toward the appropriate diagnosis of traumatic diaphragmatic hernia is a high index of suspicion in patients with blunt or appropriate penetrating trauma. Although laparoscopic or thoracoscopic management of such patients may become prevalent with increasing experience, at present the open approach and simple repair remain the mainstays of management. The patient’s survival still depends more on the severity of concomitant nondiaphragmatic injuries and in many cases the diaphragmatic laceration is the least worrisome and least morbid of the patient’s injuries. Operative repair results in a good outcome in most patients in the absence of other serious injuries.