The aim of the study is to determine the frequency and distribution of all colonoscopic pathologies, especially colorectal cancer (CRC), in Somalia between 2015 and 2020. For this retrospective and descriptive study, a total of 760 colonoscopy results were analyzed from the medical records of Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital. We excluded 175 patients with incomplete colonoscopy findings and medical records. Patient characteristics, presence of normal mucosa, presence, characteristics, localization, and histopathology of the lesion were recorded. Abdomino-pelvic computed tomography (CT) scans were evaluated. The median age of 585 patients (male; n=384, 65.6%) included in the study was 44 years (range; 19-94). 20.5% (n=120) had normal colonoscopy findings and 31.8% (n=186) had benign perianal pathologies (most common hemorrhoids; n=139, 23.8%). In 40.9% (n=239/585) of patients, lesions were detected in the colorectum and biopsy was performed. The number of cases with CRC on colonoscopy was 50 (8.5%), the most common histopathological type was adenocarcinoma (n=40/50; 80%) and the most common localization was rectosigmoid colon (n=37/50; 74%). The median age of CRC cases was 53 years (range, 29-85) and 72% (n=36) were male. The most common morphologic type of adenocarcinoma on CT image was mass-forming (n=35/40; 87.5%). In all patients, the tumor had invaded the bowel wall and periintestinal fat infiltration was present. Lymph node metastases were present in 38% (n=19/50) and distant organ metastases in 18% (n=9/50) of patients with CRC. Our study reveals that colonoscopies in Somalia mostly find perianal lesions (most commonly hemorrhoids), the incidence of CRCs is 8.5%, all CRCs are diagnosed at an advanced stage and require neoadjuvant chemoradiotherapy. Community education and screening programs should be developed to detect CRCs early in the precancerous stage and reduce mortality.