The patient, a 53-year-old female, presented to the clinic on November 26, 2008, with sudden severe pain in the left chest, chest suffocation, and dyspnea. The patient was suffering from upper abdominal and left chest discomfort six months ago, and the discomfort worsened after eating. After 12 hours of eating, he suddenly developed severe pain in the left chest, chest suffocation and dyspnea, followed by pallor, cold extremities, and decreased blood pressure with signs of shock. The patient was immediately given closed drainage of the left thoracic cavity, and 2000ml of brown purulent fluid was drained out, and local cleaning of the thoracic cavity with saline was performed, along with anti-shock treatment, the condition improved, and the chest drainage fluid changed from brown purulent fluid to yellow plasma fluid. An upper gastrointestinal tract imaging was performed, and the stomach herniated into the chest cavity and the contrast agent was seen to enter the chest cavity. Preoperative diagnosis: left diaphragm rupture, gastric perforation, left septic pneumothorax, infectious toxic shock, and thoracotomy was performed. Intraoperatively, a 5-cm rupture at the central tendon of the left diaphragm was seen, the fundus of the stomach was herniated into the thoracic cavity, and a 4-cm long rupture at the bottom of the stomach with gastric contents flowing out. After two weeks of postoperative anti-infection treatment, the thoracic drain was removed and the gastrostomy tube was removed three weeks later, and the patient was discharged. Final diagnosis: 1, spontaneous diaphragmatic rupture; 2, strangulated gastric perforation; 3, left septic chest; 4, left pneumothorax; 5, infectious toxic shock. Diaphragmatic rupture caused by blunt trauma accounts for 3% of severe thoracoabdominal injuries. The average intra-abdominal pressure is 0.2-0.98kpa (2-10cmH2O) in a normal person during calm breathing in the supine position. The pressure in the thoracic cavity is 0.49kpa (-5cmH2O) during expiration and 0.98kpa (-10cmH2O) during inspiration, and the pressure difference between the thoracic and abdominal cavities fluctuates between 0.69-1.96kpa (7-20cmH2O), and the intra-abdominal pressure rises due to coughing or impact, and the acoustic portal reflexively closes to increase the intrathoracic pressure to counteract the intra-abdominal pressure. When severe violence occurs suddenly in the abdomen and lower thorax, the acoustic portal does not close in time and the lungs lack inflation to counteract intra-abdominal pressure, causing an instantaneous and dramatic increase in the pressure difference between the thorax and abdomen, resulting in diaphragmatic rupture. It has been suggested that diaphragmatic rupture is caused by the shear forces generated by the twisting of the injured chest wall .Lucido suggests that diaphragmatic rupture occurs at a potential weak point where the right and left lobes of the diaphragm fuse embryonically and the trauma causes a sharp increase in abdominal pressure. The trauma causes a sharp increase in abdominal pressure and rupture of the diaphragm towards this weak point, but it is not possible to be clinically certain of a constant site of diaphragmatic rupture, which can in fact occur at any part of the diaphragm. Obstruction and strangulation are the greatest complications threatening the casualty, as reported by Hood: 7.7% died before surgery due to untimely surgery, 10.5% died intraoperatively and postoperatively, with an overall mortality rate of 18.2%. Different mechanisms can occur with diaphragmatic rupture, herniation of abdominal organs into the thoracic cavity, strangulated necrosis, and rapid perforation of the herniated gastric wall. If the rupture of the diaphragm is not severe after trauma, the diagnosis will be missed and the patient enters the latent phase, where the patient can be asymptomatic. 85% of patients in the latent phase have obstruction, narrower and perforation within three years after the trauma. Chronic traumatic diaphragmatic rupture occurs mostly in fall injuries because there are no obvious positive signs (about 13%) and such injuries are missed, mostly on the left side.