Background <p>There is a&#xa0;scarcity of data regarding the treatment of Crohn’s disease patients presenting with acute abdominal pain. This article presents the results of the surgical treatment in this patient cohort.</p> Methods <p>A&#xa0;retrospective analysis of a&#xa0;prospectively maintained database was carried out. All patients who underwent bowel resection for Crohn’s disease between 2016 and 2024 were included in this study. Out of the total population, patients who were hospitalized due to an acute abdomen were identified. After exclusion of peritonitis, a&#xa0;non-operative treatment was initiated in order to be able to perform elective surgery. The primary endpoint of the study was the comparison of postoperative morbidity between patients with emergency or elective hospitalization.</p> Results <p>A total of 459 patients underwent a bowel resection. Of the 78&#xa0;patients who were admitted via the emergency room, emergency surgery was carried out in 26&#xa0;(33%). In the multivariate analysis, the following factors were associated with a higher probability for failure of primarily non-operative treatment: unexpected finding of peritonitis intraoperatively and the need of colorectal resection as opposed to small bowel or ileocolic resection. Emergency patients who underwent elective surgery after successful initial non-operative treatment had an intraoperative and postoperative outcome comparable to patients who were hospitalized electively. In patients who underwent emergency surgery, laparoscopic surgery could be carried out less often, the resected specimens were longer and an anastomosis was performed less frequently; however, the postoperative morbidity was not elevated.</p> Conclusion <p>After exclusion of peritonitis, Crohn’s disease&#xa0;patients with acute abdomen should primarily undergo an attempt of nonoperative treatment, however, the latter fails more often in patients with colonic involvement.</p>