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Mesenteric vascular injuries following blunt abdominal trauma are uncommon and diffi cult to diagnose. A 33-year old restrained front seat passenger presented with chest and abdominal pain following a head-on collision. Initial evaluation was unremarkable except for diagonal chest and transverse lap seatbelt marks. A day after admission the patient’s abdomen became  increasingly tender. An abdominal ultrasound scan revealed free fluid in the abdomen. Laparotomy revealed hemoperitoneum, tear of the mesentery and gangrene of the small intestines. The case is presented to show delayed onset of significant symptoms and signs. Trauma teams should have a high index of suspicion for mesenteric vascular injuries in patients who present with the seatbelt mark when evaluating the blunt trauma abdomen.