Vascular injuries from blunt trauma are rare in children. This report concerns traumatic occlusion of the common iliac artery with limb-threatening ischemia in a 6-year-old boy sustained while wearing a lap belt. Associated injuries included fracture of the third lumbar vertebra, perforation of the sigmoid colon, and disruption of the anterior abdominal wall musculature. Because of fecal contamination from the colon perforation, revascularization using a subcutaneous prosthetic femorofemoral artery bypass was performed and proved successful in limb salvage. As improved prosthetic vascular conduits of smaller caliber are developed, applications in small children with vascular injuries may increase.