Three cases of spontaneous perforation of granulomatous colitis are presented. The typical features are those of acute right iliac fossa pathology mimicking appendicitis. Differential diagnosis is difficult in our locality but includes essentially Crohn's colitis although tuberculous and other inflammatory colitis could not be definitively excluded. In the absence of facilities for laparoscopy or even ultrasound-guided percutaneous drainage the results of open laparotomy with right hemicolectomy were beneficial. As expected in our community follow up responses were poor making it difficult to predict long term outcomes. A plea is made for practitioners to bear unusual pathologies in mind during practice.