With the introduction of the use of seatbelts in cars, mortality following motor vehicle crashes has decreased significantly. However, two patterns of injuries, the ‘seatbelt sign’ and ‘seatbelt syndrome’ have emerged. Injuries may consist of traumatic abdominal wall disruption. We present two cases of severe abdominal wall disruption caused by a seatbelt injury and treated with primary repair. A review of the literature is provided. Two patients were brought in after a high velocity Motor Vehicle Collision. Both presented with an acute abdomen and a seatbelt sign upon which the decision was made to perform emergency laparotomies. Both patients had an abdominal wall disruption along the seatbelt sign. These disruptions were primarily closed and during six months of follow-up no complications occurred. A disruption of the abdominal wall is a rare complication. However, it is a diagnosis that may not be missed as patients have a higher risk of morbidity and mortality. CT-scanning is an accurate method to detect disruptions. Closure of blunt traumatic abdominal wall disruption can be done primarily with sutures or addition of a mesh. In both cases of the severe abdominal wall disruption, primary repair without mesh in the acute phase was successful. When a laparotomy is not indicated, the abdominal wall must be assessed for disruption. If there is a disruption primary repair is a good option.