Colorectal carcinoma (CC) is a rare disease in the pediatric population with an annual incidence of 1 in 10 million adolescents, and comprises approximately 1% of pediatric neoplasms. It is the most common primary gastrointestinal malignancy in children with the vast majority of CCs being adenocarcinoma (CA). Unfortunately, the proportion of poorly differentiated, mucinous type, signet-ring cell containing carcinomas is higher in younger patients than in adults. Moreover, due to the low awareness of the disease, diagnosis is usually delayed until the disease is in an advanced stage, causing prognosis to be extremely poor. Surgery is the only curative modality for localized CAs, instead, for patients with cancer staging III, adjuvant chemotherapy is mandatory to eradicate micro-metastases. In the last ten years we treated 3 patients diagnosed with CA: a 14-years-old female, a 15-years-old male, and a 15-years-old female. They presented all to our ED with nonspecific symptoms of abdominal pain and vomits. All were subjected to laparoscopic tumor resection to relief intestinal obstruction. In the male patient laparoscopy was converted to laparotomy for safely understanding the anatomy, due to strong peritoneal adhesions. No stomas were performed, in order to improve quality of life. Oxaliplatin and 5-fluorouracil-based antineoplastic agents were among the commonly used chemotherapy combinations. The 15-years-old female and the 15-years-old male died one year after the surgical resection, while the 14-years-old female is still on follow-up. CAs behave aggressively in children; not only have they a poorer response to chemotherapy, but also are associated with extensive intramural spread and peritoneal carcinomatosis. Awareness and early intervention remain the main challenges in the early diagnosis and prognosis of CA.