Tuberculosis (TB) remains one of the leading causes of childhood morbidity and mortality worldwide, with India bearing a significant proportion of the global burden. Abdominal tuberculosis (ATB), although rare in children, presents a major diagnostic challenge due to its nonspecific clinical manifestations and low microbiological yield. This study aimed to evaluate the clinical profile, diagnostic approaches, and outcomes of pediatric abdominal TB cases. A retrospective review was conducted over a one-year period (January–December 2022) at the Intermediate Referral Laboratory for Tuberculosis, Government Medical College, Jammu. A total of 347 extrapulmonary TB samples, including gastric lavage, peritoneal fluid, and ascitic fluid, were analyzed using clinical, radiological, and microbiological methods, with CBNAAT employed for confirmation. Of these, 323 samples were from pediatric patients, and 8 (2.5%) were confirmed positive for Mycobacterium tuberculosis. The predominant symptoms included abdominal pain, fever, weight loss, diarrhea, and abdominal lump, often associated with ultrasound/CT findings of bowel thickening, lymphadenopathy, and mild ascites. A family history of pulmonary TB was present in all cases. Treatment consisted of a six-month regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol, resulting in recovery in 50% of patients, while four children, including one defaulter, succumbed to the illness. The study highlights the importance of maintaining a high index of suspicion for pediatric ATB, particularly in endemic regions, and underscores the need for early diagnosis through imaging and molecular methods. Despite poor microbiological yield, timely initiation of therapy can improve outcomes. Strengthening awareness and early detection strategies are crucial to reducing the disease burden.

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