Background and aims Diagnosis of Crohn’s disease (CD) is still challenging in our country. We aimed to assess if there were distinctive features of children whose CD was diagnosed after emergency surgery (ES), performed for other presumed conditions.

Methods From the inflammatory bowel disease database of our tertiary referral centre (1998–2016), we retrospectively retrieved data of all patients with CD. To compare patients diagnosed after surgery (SCD) with those medically diagnosed (MCD), we used STATA software version 13.

Results Forty-four patients were diagnosed with CD [mean age (± SD) at diagnosis 12.5±3.9 years, mean duration until diagnosis 13.2 months, 68.1% male], belonging to 18 counties (44% of the country). Nine (20.4%) had ES (peritonitis – 2 and misdiagnosis of: appendicitis – 4, Meckel diverticulum – 1, anal condyloma – 1 and colonic tumour – 1) and were confirmed as CD. In children with SCD (vs MCD) we found: lower rate of hospitalizations (10.5 vs 83.3%, p=0.001), lower number of hospitalisations (no hospitalisation in 83.3 vs 10%, p=0.002), more B2 and/or B3 behaviour (55.5 vs 8.6%, p=0.005), more frequent presence of granulomas in biopsies (55.2 vs 20%, p=0.03), less frequent weight loss (55.5 vs 94.3%, p=0.01) and less frequent loss of appetite (55.5 vs 85.7%, p=0.01). In multivariate analysis, only number of previous hospitalisations [RR:−0.54, 95% CI: (−0.86) – (−0.23), p=0.001)] and behaviour (RR:0.02, 95% CI: 0.04–0.32, p=0.009) were significantly associated with SCD. No significant difference between the two groups was found for demographic data (gender, environmental habitat), psychological trauma, symptoms at onset, growth delay, age at onset and at diagnosis, location of CD, perianal disease, extraintestinal manifestations and immunological data.

Conclusions In a country where CD was previously uncommon, one fifth of children are diagnosed only through emergency surgery, for other presumed conditions. Even if these children had less hospitalisations and more complicated behaviour, the duration from onset until diagnosis was not significantly different from those diagnosed medically. Given also the long delay until diagnosis (13.2 months) versus Western countries, it appears clearly that physicians are not aware of this condition yet. It is imperative that doctors become familiar with manifestations of CD, in order to provide a proper management of the disease and prevent complications.