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Idiopathic ulcer of the cecum has been considered a rare condition requiring surgical treatment because of a high incidence of complications, including bowel perforation. Cecal ulcerations are usually diagnosed at the time of surgery for presumed appendicitis or peritonitis of unknown origin. Preoperative diagnosis of cecal ulcer by barium enema has been unreliable and previous literature cites only one case diagnosed by colonoscopy. We describe four cases in which the diagnosis was made at colonoscopy. Three of our four patients were treated conservatively and did not require laparotomy. Idiopathic cecal ulcer should be considered in the differential diagnosis of lower gastrointestinal hemorrhage as well as atypical appendicitis. If the diagnosis of cecal ulcer is made by colonoscopy in a patient without evidence of an acute abdomen, conservative management may be followed by complete healing, avoiding unnecessary surgery.