Two cases of severe duodenal injury following child abuse are presented. One avulsion injury required pyloric exclusion. Both 2-year-old children survived without anastomotic complications. Survival after these injuries rests on the ability to apply multiple techniques for duodenal reconstruction, as well as the recognition of individual cases of abuse-associated malnutrition. A high index of suspicion following abuse-associated blunt abdominal trauma will prevent diagnostic delay in children with retroperitoneal duodenal injuries.