Pipe elbows are essential connection components between the storage terminal and conveying pipelines in the petrochemical industry, which are prone to rupture and perforation under various potential impact loads. In this paper, the rupture and perforation responses of pressurized pipe elbows subjected to transverse impact loads were systematically investigated. Perforation phenomena of pipe elbows were qualitatively analyzed to identify the failure modes and features. Perforation mechanisms of mode transition, transient deflection, velocity variation, and stress distribution were systematically discussed. Extensive parametric studies were performed to investigate the deflection and mechanical responses. Parametric equations were established to describe the critical impact resistance. These results revealed the perforation phenomena and impact limits of pipe elbows subjected to impact loads, which are informative for protection design and damage assessment of pressurized pipe elbows.