Methods: A retrospective study of children aged < 18 years, diagnosed with abdominal tuberculosis From Jan- 2023 to July 2024 in department of Paediatric Gastroenterology at PGICH Noida. Both Confirmed cases (Tubercular bacilli isolated either through microscopy, culture or PCR based Test) and clinically diagnosed tuberculosis cases (on basis of symptoms, biochemistry, Imaging endoscopy and clinical response to ATT with no relapse after 3 months of ATT) were Enrolled Clinical, endoscopic, lab data and management were analysed. 

Results: 76 children were studied with median duration of symptom 2 (15 days to 3 yrs) months and age 12 (3 yrs to 18 yrs) years. Girls were 66% (n=50). Most common symptomswere pain abdomen( 88 % , n=66) , anorexia(n=74%, n=56) , weight loss(69%, n=52 )Mixed variety of abdominal tuberculosis (64%,n=47) was most common followed by intestinal (30%,n=22), lymph nodal (5%,n=5) and peritoneal (1%,n=2). Concomitant pulmonary involvement was seen in 58%(n=44) . Diagnosis was microbiologically confirmed in 10% (n=8) and clinically diagnosed in 90% [(n=68) made on imaging , typical colonoscopic findings of wide gaping IC valve with deep circumferential ulcers in cecum 50%, typical histopathology findings of caseous necrosiswith granuloma in 13%.40 percent patients(n=31) presented with subacute intestinal obstruction, 7 percent(n=5) hadperforation with ileum being the most common site of perforation.Surgery was required for ileal (n= 3)or jejunal (n=2 ) in 7% at the time of diagnosis.12percent (n=9) developed DILI over 6 months follow up period . 

Conclusion: Abdominal TB presents with pain abdomen, weight loss and anorexia, is often missed by pediatrician because of non specific presentation and diagnosis is most often made on clinical basis (symptoms with imaging along with response to ATT) . Microbiological confirmation could be possible in 10 percent cases only.