Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), frequently presents with acute complications that necessitate rapid evaluation and surgical intervention. For primary assistant physicians and emergency care providers, early recognition of these life-threatening scenarios is essential to reduce morbidity and mortality. This chapter provides an evidence-based overview of the major surgical emergencies associated with IBD, emphasizing their pathophysiology, clinical presentation, diagnostic evaluation, and principles of initial management. In CD, emergent indications include bowel obstruction, perforation, intra-abdominal abscess, massive hemorrhage, and perianal sepsis. Timely identification of obstructive or penetrating disease and prompt coordination of surgical drainage, resection, or diversion are critical, particularly given the limitations of medical therapy in these settings. Postoperative complications—such as thromboembolism, anastomotic leak, intra-abdominal sepsis, and obstruction—are also highlighted due to their high incidence in CD patients who often present with malnutrition and immunosuppression. In UC, fulminant colitis, toxic megacolon, massive hemorrhage, and perforation represent the principal indications for emergency colectomy. The chapter outlines the importance of aggressive resuscitation, broad-spectrum antimicrobial therapy, and early surgical consultation, as delays markedly worsen outcomes. Postoperative complications following emergency colectomy or ileal pouch–anal anastomosis (IPAA)—including sepsis, small bowel obstruction, pouch-related infections, and high-output ileostomy—are reviewed with a focus on early detection and stabilization strategies. Through a comprehensive synthesis of clinical evidence, this chapter equips frontline providers with practical, guideline-aligned approaches to the acute management of IBD surgical emergencies. Enhanced awareness and timely intervention can substantially improve survival, postoperative recovery, and long-term outcomes for patients with complex IBD.