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Introduction:The effects of surgical versus medical management of appendicitis in Crohn's disease (CD) patients remain unknown. Our aim was to evaluate outcomes of CD patients who have undergone operative versus non-operative treatment of acute appendicitis. Methods: We performed a retrospective cohort study of adult CD patients presenting to the University of Minnesota with acute appendicitis between 1/1/2015 and 12/31/2020. Electronic health records were reviewed for demographics, CD classification, medications, disease activity, appendicitis course and subsequent complications and disease outcomes. A t-test was used to compare continuous variables and Fisher's exact tests were used to compare categorical variables. Univariate logistic regression was used to compare outcomes for those treated with operative versus non-operative management of appendicitis. Results: We identified 24 patients with CD who underwent treatment for appendicitis. Eight patients (33%) received nonoperative management with antibiotics. Sixteen patients (66%) had surgical management. Of those managed with surgery, 4 (25%) were treated with concomitant antibiotics. Crohn's disease activity, measured using the physician global assessment (PGA), was similar in both groups. Five patients (63%) in the medically managed group had a CD flare on admission compared to one (6%) in the surgically managed group (63% vs 6%, p, 0.01). Four patients (50%) treated with antibiotics eventually required an appendectomy. No differences in length of stay, rate of complications up to 6 months, time to subsequent CD-related surgery or time to CD flare were seen between the two groups. Conclusion: In CD, antibiotic therapy alone can be an effective and safe option for the treatment of acute appendicitis, especially in patients presenting with a concomitant flare. Non-operative management can also help avoid eventual surgery in half of patients. Further data are needed to better characterize individual risk factors and outcomes in this patient population and shared decision making should guide current management.

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