At the Adams Cowley Shock Trauma Center, 80 patients with ruptured diaphragm were admitted between 1986 and 1991. The management of patients with delayed diagnosis may present a challenging surgical problem. Repair is typically accomplished via the transthoracic route and may require use of fascia lata or synthetic patch in order to close large defects in the hemidiaphragm. We describe a case in which a massive diaphragmatic rupture was repaired utilizing a synthetic patch