Acute diaphragmatic injury resulting from penetrating or blunt trauma represents a challenging clinical entity. Preoperative diagnosis remains difficult in 50% to 70% of patients, and a timely diagnosis requires a high index of suspicion. Once recognized, the usual aspects of surgical repair are straightforward, such as single layer repair using heavy non-absorbable suture via the transabdominal approach. However, complex injuries such as parahiatal defects, defects involving the diaphragmatic pericardium, diaphragmatic avulsion, and injuries with massive tissue loss can test the surgeon's skill and creativity. Prioritization of management in patients with multiple significant traumatic injuries demands a well-organized approach with availability of highly specialized resources and a well-coordinated trauma and critical care team.