Initial surgical management is the most effective approach for intra-abdominal abscesses in Crohn’s disease.

• Initial surgery has the lowest reoperation rate at 21%, compared to 48% for medical management and 47% for percutaneous drainage (PD).
• PD leads to fewer complications than surgery (odds ratio 0.48) and may serve as a safer interim solution.
• Medical management should be limited to select patients due to higher surgical intervention rates.

Choosing initial surgery can optimize patient outcomes in this setting.