Background: Abdominal tuberculosis encompasses disease of any intra-abdominal organ and any part of the gastrointestinal tract from mouth to anus. Solid organs are involved through haematogenous dissemination, whereas the gastrointestinal tract is affected either through the ingestion of infected lung secretions, by contiguous invasion from infected lymph nodes, or through dairy products contaminated with M. bovis. There is a strong historical association between advanced pulmonary tuberculosis and gastrointestinal tuberculosis, reflecting the importance of swallowing infectious respiratory secretions to the pathogenesis of this disease. The clinical manifestations of abdominal tuberculosis are protean, dependent upon the organs involved. Ulceration, stricture, perforation and fistula formation are the cardinal pathological features of gastrointestinal tuberculosis, with additional complications dependent upon which segment of the bowel is involved. For example, serious bleeding may complicate gastric and colorectal tuberculosis, whereas malabsorption more commonly results from small bowel infection. Jejunoileal and ileocecal tuberculosis is the commonest part of the bowel to be affected by tuberculosis, occurring in 50–70% of all forms of abdominal tuberculosis. The commonest symptom is abdominal pain, which is reported by 90% of patientsIleojejunal/caecal tuberculosis typically presents with days or weeks of colicky abdominal pain, borborygmi and vomiting. Examination may reveal a mass in the right lower quadrant. The most common complication is sub-acute intestinal obstruction, although acute-on-chronic abdominal pain may indicate perforation. In India, tuberculosis is the second commonest cause of bowel perforation to typhoid. Tuberculous perforations are usually single and proximal to a stricture. Isolated colonic disease presents with pain, change in bowel habit and bleeding (in 70%). The disease is multifocal in one-third with diffuse ulceration mimicking colitis. Hepatic, pancreatic and splenic tuberculosis often accompany military tuberculosis, as do multiple peritoneal tubercle deposits. Enlarged intra-abdominal lymph nodes typically accompany this form of the disease. Presentations may include following Abdominal TB often presents with fever, weight loss, and abdominal pain. Negative chest radiograph or negative tuberculin skin test does not exclude extrapulmonary TB, it may or may not have evidence of pulmonary TBor positive tuberculin test Possibly negative in immunosuppressed, malnourished, or severe disseminated disease Other signs/symptoms -Peritonitis is most common clinical manifestation of abdominal tuberculosis -Affects 1/3 of patients; 90% with ascites (wet type) Adrenal tuberculosis -Addisonian presentation (adrenal insufficiency, hypotension, and electrolyte disturbances) -Gastrointestinal TB Usually few or no symptoms (partial obstruction). Results: In our study highest incidence of abdominal Koch’s was found in 0-20 year and 21-40 year age groups i.e. in 19(38.0%) & 18(36.0%) respectively. Pain in abdomen was most commonly found symptoms, reported in 48(96.0%) out of 50 patientsNext commonly presenting symptom was loss of appetite, reported in 34(68%) out of 50 patients. It is followed by fever, constipation, loss of weight anddistension of abdomen in 44%, 38%, 30% & 22% respectively. Lump in abdomen was seen only in 2 patients out of 50.In our study, out of 50 patients 88% received ATT category 1 (out of which 11 patients were operated up to), rest 12% received ATT category 2 (out of which only 1 patient was operated upon). All patients reported relief in symptoms in about 4 to 6 weeks after starting ATT. Conclusion: The patient often comes with vague clinical features, and hence it is difficult to diagnose the condition. Diagnosis of abdominal tuberculosis can only be made after correlating clinical presentation with biochemical and radiological investigations. Plain X ray chest and abdomen coupled with ultrasonography of the abdomen are the investigations of choice in acute cases. The disease has high morbidity and mortality in emergency surgery probably due to inadequate bowel preparation, contamination and fluid electrolyte imbalance. Tuberculosis is common in patients with HIV infection, necessitating screening for HIV for all patients. Neither clinical signs and symptoms, laboratory investigations, radiological and endoscopic methods, nor bacteriological and Histopathological findings providea gold standard by themselves in the diagnosis of abdominal TB. Therefore, a large number of Koch’s abdomen cases still remain undiagnosed. As the disease is severe and diagnosis is elusive, high degree of clinical suspicion is required for timely management and better outcome.