Introduction: Information on extra-intestinal manifestations (EIM) in paediatric inflammatory bowel disease (PIBD) in the Sri Lankan setting is limited. Objectives: To describe the prevalence and presentation pattern of EIMs in a Sri Lankan PIBD cohort. Methods: The Gastroenterology clinic of Lady Ridgeway Hospital has collected data on patients who receive care for PIBD. Data on 141 patients were analysed retrospectively . Results: 50 patients (35.5%) suffered from EIMs. This was significantly higher than in other PIBD cohorts with published data (35.5% vs 16.7%, p=0.000). 64.0% of them (32/50) had a single EIM, while 36% (18/50) had multiple EIMs. The prevalence of Crohn’s disease, ulcerative colitis, and inflammatory bowel disease-unclassified were 58% (29/50), 34% (17/50), and 8% (4/50), respectively . There was no significant difference compared to the population (p=0.327). The majority (60%,30/50) were females, and the mean age was 9.20 years, which were not significantly different from the population (p=0.511 and p=0.315). Most prevalent EIMs were peripheral arthritis (12.0%, 17/141), hepatomegaly (10.6%, 15/141), and aphthous stomatitis (7 .8%, 11/141). The prevalence of primary sclerosing cholangitis (PSC), sacroiliitis, erythema nodosum, pyoderma gangrenosum, and uveitis were 10.6%, 2.8%, 3.5%, and 2.1%, respectively . The most common 1st EIM in patients with multiple EIMs was aphthous stomatitis (22.2%, 4/18). Median time from disease diagnosis to the 1st EIM was 5.50 months (range 0.33-156). Conclusions: The Sri Lankan PIBD cohort has a higher prevalence of EIMs compared to its global counterparts. The commonest EIM was peripheral arthritis; the fact that this is a single-center study remains a limitation.