BACKGROUND: Extraintestinal manifestations significantly affect the quality of life of patients with Crohn’s disease. The aim of the present study is to define the risk factors for extraintestinal manifestations and the relative influence of intestinal surgery. PATIENTS AND METHODS: In a cohort of 223 patients with Crohn’s disease we analyzed the association between demographic/clinico-pathological factors and extraintestinal manifestations. In addition, we evaluated their association with the timing of appearance of the extraintestinal manifestations with respect to the intestinal surgery. RESULTS: Fifty-seven patients (25.6%) developed 91 extraintestinal manifestations. Demographic and clinico-pathological variables significantly associated with extraintestinal manifestations were: female gender (OR 2.84, 95% CI: 1.37-5.90) and colonic involvement (OR 2.68, 95% CI: 1.06-6.76). In patients not undergoing surgery and in patients with extraintestinal manifestations present only before surgery, the latency period between the onset of Crohn’s disease and extraintestinal manifestations were 3.7 ± 8.2 and 2.1 ± 6.3 years, respectively. In patients developed extraintestinal manifestations only after surgery, the latency between surgery and extraintestinal manifestations was 12.0 ± 10.0 years. In 5 patients with early onset of extraintestinal manifestations, these did not regress or recur after surgery. CONCLUSION: Female gender and colonic involvement are confirmed as risk factors for the development of extraintestinal manifestations in Crohn’s disease. Surgical treatment of the intestinal disease represents a therapeutic option for patients with extraintestinal manifestations, as it seems to prevent or delay these manifestations in most cases.