Identification of tuberculosis among children poses technical and operational challenges. Abdominal tuberculosis (ATB), where the variable clinical manifestations continue to challenge the physicians in its diagnosis and therapy. Methods: Medical records of 115 patients who were diagnosed with ATB over a period of six years were studied retrospectively. Details of history, physical examination and investigations, treatment and outcome of therapy were evaluated. Results: The mean age of the patients was 6.4 years. Commonest symptom at presentation was abdominal pain, followed by fever. Nine patients presented with acute abdomen. Mantoux test was positive in thirty nine percent and accelerated BCG reaction was found in 40.1% percent. Verification of most important focus was found in 41.9 % of chest radiographs. Commonest ultrasonography and computed tomography findings were mesenteric thickening, followed by intra –abdominal lymphadenopathy. Tuberculous infection could be confirmed in 38 patients. The classical plastic variety was the commonest type of ATB found. A complete cure with antituberculous drugs was documented in over 90 percent of the patients. Conclusion: In high frequency zones, ATB must be considered as a differential diagnosis in children presenting with non-specific constitutional symptoms and abdominal pain. When confirmatory tests are not available, supportive investigations and clinical suspicion should be careful powerfully for diagnosis of ATB to avoid delay in treatment. Timely use of laparoscopy and laparotomy may be required for confirmation of diagnosisddd |