A 65-year-old man with a history of thoracic contusion due to a traffic accident 15 years ago was admitted to our hospital because of dyspnea on effort and an abnormal shadow on a chest radiograph. Multiplanar reconstruction (MPR) of multi-detector CT clearly revealed a right diaphragmatic rupture and intrathoracic hernia containing the whole liver, gallbladder, distal stomach, duodenum, and portions of the ileum and colon. Thoracoscopic observation followed by an operation involving a thoracoabdominal approach confirmed the condition of the hernia. The ruptured diaphragm was repaired using an expanded polytetrafluoroethylene (ePTFE) patch. Intensive respiratory care was required during the postoperative course because of insufficient spontaneous ventilation and increased abdominal pressure secondary to paralytic ileus.