Diaphragmatic injury is a rare sequelae of blunt abdominal trauma. Here we present a case of blunt abdominal trauma resulting in multiple diaphragmatic and intraabdominal injuries. The patient is a 44 yr old male who was involved in a high speed rollover motor vehicle collision. The patient was intubated on arrival to the emergency department secondary to decreasing mental status and respiratory distress. A chest X-ray revealed an opacified left chest. Tube thoracostomy placement resulted in an initial 1600cc of blood return followed by 1100cc of blood. The patient was brought to the operating suite where a diagnostic peritoneal lavage was performed, revealing gross blood. On exploration of the abdomen, a rupture of the diaphragm with intraabdominal herniation of the heart was found. A liver laceration and ruptured spleen were also present. Hepatic laceration repair, splenectomy and diaphragmatic repair were performed. Chest tube output was yet another 1000cc of blood and a left thoracotomy was performed. This revealed a large posterolateral rupture of the left diaphragm with intrathoracic herniation of bowel and splenic bed. The diaphragm was repaired and the patient was monitored in an intensive care setting. The patient continued to progress well. Other injuries included a comminuted fracture of left clavicle, and comminuted fracture of acetabulum and inferior and superior rami, for which the patient was ultimately transferred. Prior to transfer the patient did have a fluid collection around the pancreas drained. Overall, diaphragmatic injuries are not a common finding in blunt trauma. However, we present a case of multiple diaphragmatic injury after a common blunt trauma mechanism.