Diaphragmatic rupture (DR) is a life–threatening condition and often results from either blunt or penetrating trauma. (DR) is usually associated with abdominal trauma however, it can occur as isolated injury. Acute traumatic rupture of the diaphragm may be silent and there is often a delay between the injury and the diagnosis. Tension gastrothorax(TGT), tension colothorax(TCT) and tension hepatothorax(THT)are life–threatening conditions and present dramatically with acute and severe respiratory distress. It develops when an intra–thoracichreniation of stomach,liver or colon through a diaphragmatic defect. Massively distended stomach and colon by trapped air or fluid causing mediastinaldisplacement. (TGT),(TCT)and (THT)is often missed as tension pneumothorax and managed as such leading to increased morbidity and mortality. Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach,colon and liver. Reduction of herniated viscera must be done with laparotomy and repair of the diaphragmatic defect.Here we present five cases with(TGT),(TCT)and (THT).We have performed transthoracic decompression of stomach and colonin three caseswith chest tube insertion and emergencylaparatomy. In two cases,right sideemergency thoracotomy was performed. The aim of this report is to show our experiences in diagnosis,emergency management and repair of large defect of diaphragm. Because these unusualemergency condition, tension(GT),(TCT)and (THT) andreconstruction of large diaphragmatic defects with synthetic prosthesis has not been well characterized in emergency presentations of delay diaphragmatic hernia andare still a challenging issuein the literature reviews.