Spontaneous perforation of the colon is rare and is classified as "Idiopathic" and "Stercoral." Four patients with a total of 5 episodes of spontaneous perforation of the large bowel treated at the department of surgery, Rustaq hospital over the past 5 years are presented in this study as well as a literature review of clinical and pathological characteristics of each case. Spontaneous perforation of the colon should be considered in the differential diagnosis of patients with acute peritonitis and free gas under the diaphragm. The condition is usually associated with chronic constipation and the use of NSAIDs. Early surgical intervention reduces morbidity and mortality.