Objective: The coronavirus disease 2019 (COVID-19) pandemic has resulted in many alterations in the management of surgical patients. We share our experience with surgical emergencies during the COVID-19 pandemic and their subsequent 3-year follow-up. Materials and methods: This observational study was conducted over 1 year. Demographic details, diagnosis, surgery, COVID-19 test results, inflammatory markers, days of hospital stay, and complications were collated from inpatient files, discharge summaries, and outpatient records. The follow-up data were collected by reviewing outpatient cards and conducting telephonic interviews. Results: A total of 70 children underwent emergency procedures. The age ranged from 0 to 17 years, and 60% were males. COVID-19 testing was done as per the institution's protocol. Around 27.1% were COVID-19 positive and underwent laparotomy, peritoneal dialysis catheter insertion, ventriculoperitoneal shunt revision, and central line insertions. Bowel gangrene secondary to vascular thrombosis in one child and burst abdomen following pyloromyotomy in another child were unique pathologies that could be attributable to COVID-19. The average hospital stay was 10.1 ± 5.5 days. The remaining 51 children underwent mostly laparotomy, endoscopy, and bronchoscopy. Conclusion: Surgical pathology dictates outcome in COVID-19-positive children. Vascular thrombosis-induced complications may be of concern but are amenable to timely intervention. Routine screening and following universal protocols ensure collateral protection. The use of prophylactic antibiotics and anticoagulants in COVID-19-positive surgical children needs validation in larger cohorts.