Background: Pediatric surgical abdominal emergency is a serious condition with reported high mortality in Africa and Bugando Medical Centre in particular. This study aimed at understanding the clinical pattern and predictors of early outcome of pediatric surgical abdominal emergencies at Bugando Medical Centre. Methods: A longitudinal descriptive study involving 130 patients with PSAE at BMC from November 2020 to May 2021. Patients were fully investigated and operated as per standard guidelines. Structured questionnaire was used to collect data which were analysed using STATA version 13. A p-value of less than 0.05 was considered significant. Result: A Male: Female ratio of 1.7:1 was noted, the median age of patients was 3years majority presenting with abdominal distension (94.6%), abdominal pain (91.5%) and vomiting (76.2%). The leading cause of Paediatric surgical abdominal emergencies were intestinal obstruction (66.0%) and peritonitis (21.8%). Short hospital stay (61.5%) was the commonest outcome followed by prolonged hospital stay (38.5%), and death (19.6%). Adolescent age (p-value=0.022) and rural residence (p-value=0.042), were significantly associated with increased duration of hospital stay while hyponatremia (p-value= 0.001), hypokalaemia (p-value=0.001) and low haemoglobin level (p-value=0.05) were found to significantly predict mortality. Conclusion: Intestinal obstructions and peritonitis are the commonest cause of PSAE at BMC, often presenting with abdominal pain and distension. Majority of patients have a short hospital stay, but adolescence and rural residence are associated with increased length of hospital stay. Electrolyte imbalance is significantly associated with mortality which was found to be decreasing but remains high at BMC.