A review of our past year's trauma experience revealed that we admitted an average of three patients per month with blunt diaphragm rupture, a total of 39 ruptures in 37 patients. Twenty patients (54%) presented to the emergency room in shock. Thirty patients (81%) required urgent airway intervention. All but one patient had associated injuries. Diaphragm rupture is difficult to diagnose; it was not initially recognized in 69% of cases. Chest roentgenogram was often nondiagnostic. Peritoneal lavage gave false-negative results. We ultimately failed to diagnose diaphragm rupture in only three cases. We attributed our low incidence of missed injury to an aggressive approach in the severely injured patient population, where exploratory laparotomy is a routine part of the complete evaluation. One third of the ruptures were on the right side. The complication rate was 82%, excluding a mortality rate of 40.5%. High morbidity and mortality were related primarily to associated injuries.