The constellation of abdominal injuries caused by seat belts in automobile accidents usually consists of intraabdominal solid organ and hollow viscus injuries. We present a two-and-one-half-year-old patient with an unusual constellation of seat belt injuries that presented as bilateral abdominal herniations. We feel that an abdominal hernia caused by a seat belt injury should alert the clinician to the probability of other severe intraabdominal injuries. The uniqueness of this case is compounded by the way in which the seat belt was misused.