Crohn's disease in combination with ulcerative colitis is one of the two most recognized inflammatory bowel colitides. First presentation at the onset of Crohn's disease varies widely among individuals, with toxic colitis and megacolon being the most severe and often most remembered presentation. Medical registrars and acute physicians alike are faced with making decisions about admission and discharge of patients with acute abdominal pain, and awareness of the diversity of Crohn's disease pathology is of paramount importance in order not to discharge patients prematurely. This article discusses the six most common presentations of Crohn's disease to the Acute Medical Unit and informs about optimal management.