Perforations in the colon are diseases with serious consequences. Symptoms depend on the cause of perforation, size of fistula, intestinal contents and the local and global body's defence. Perforation of the gastrointestinal tract leads to acute abdominal symptoms whose exponent is usually diffuse or limited peritonitis. The main cause of perforation is cancer of the colon and rectum, and complicated diverticulitis of the colon. Currently a major problem is intestinal fistulas after surgical resection and as the result of iatrogenic complications. The basic principle followed in these cases is prompt diagnosis and early treatment, including immediate laparotomy in order to eliminate the source of infection.