Little attention has been paid to the anatomopathological factors and pathophysiologic mechanisms involved in CRC perforation. Perforation is one of the most serious complications occurring up to 11% of the cases and may also be the first manifestation of the tumor. Differentiation and angiogenesis have an important role in the tumor perforation mechanism. On the one hand, a greater expression of vascularization optimizes the supply of oxygen to the tumor and thus entails a lower necrotic wall rate and thus of perforation, on the other it is associated with a lower rate of differentiation and hence to a more aggressive cancer cells.