Despite lesser incidence and disease severity of COVID-19 in children, growing evidence of heterogeneity in clinical presentation viz., extra-pulmonary manifestations and inflammatory syndromes emphasize the importance to understand atypical presentations. We describe an 11-year-old boy presented with fever, loose stool, transient maculopapular rash over both feet, severe abdominal pain with guarding suggestive of the acute abdomen that later turned out to be COVID-19 positive in the second RT-PCR swab based on suggestive lab parameters and high clinical suspicion. The child didn't have respiratory symptoms, and both parents were tested negative for COVID. Our case brief depicts one of the uncommon presentations – 'Acute Abdomen' of this novel virus infection in children, unravels the difficulties in reaching the diagnosis and discuss the treatment dilemmas involved in these hyper-inflammatory presentations. We hope this case would sensitize the paediatricians, pediatric surgeons to suspect COVID-19 in such conditions, especially before proceeding for surgical exploration.