Traumatic diaphragmatic rupture is an uncommon but important problem in patients with multiple injuries. A retrospective analysis of 37 cases with diaphragmatic injuries, 34 of the left and 3 of the right hemidiaphragm, was carried out. Thirty-two patients were treated surgically during the acute phase and 5 after a variable delay post-trauma. Diagnostic problems are discussed, so also for comportance of a proper evaluation of chest films. Factors leading to a strong suspicion of diaphragmatic rupture in patients suffering from thoraco-addominal blunt trauma are emphasized in order to recognize diaphragmatic lesions. Finally, surgical treatment is considered. In most cases, laparotomy is the access route of choice, not only to achieve reduction of herniated viscera and repair of the diaphragmatic lesions, but also to treating the frequently associated intra-abdominal injuries. Whenever thoracotomy is required, it should always be performed via a separate incision.