Cut or Treat: Surgery or Medical Management of Patients with Crohn's Disease and Evidence of Acute Appendicitis.

The clinical presentation of Crohn's disease (CD) is heterogeneous, reflecting its involvement of any segment of the gastrointestinal tract. Acute right-lower-quadrant pain in CD can closely mimic appendicitis, creating diagnostic and therapeutic challenges. We report a 33-year-old man with established inflammatory ileocolonic CD in clinical remission on infliximab who presented with recurrent right-lower-quadrant pain and imaging findings consistent with acute appendicitis. Colonoscopy demonstrated only mild inflammatory changes without appendiceal orifice involvement. Though initial medical management with antibiotics led to transient improvement, symptoms recurred, prompting a limited appendectomy. Intraoperative evaluation revealed no active ileal or cecal inflammation. Pathology confirmed acute appendicitis without granulomas or definitive features of CD. The postoperative course was uneventful. This case highlights the importance of careful assessment of CD extent and severity using imaging and endoscopy to guide management decisions. Accurate differentiation between acute appendicitis and flare of CD is essential for optimizing medical therapy and surgical planning while minimizing complications.