A woman in her late 70s presented to the emergency department with acute respiratory distress, four days after localised trauma to the right side of the chest. Diagnostic investigations revealed a diaphragmatic rupture with visceral herniation. Laparoscopic repair was performed with repositioning of ischaemic colon, closure of the diaphragm and a right hemicolectomy with end-to-end ileo-transversostomy. A subsequent empyema required video-assisted thoracoscopic surgery and antibiotic treatment. Eventually, the patient made a full recovery.