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Idiopathic chronic ulcerative enteritis is uncommon. It is a term that describes ulceration of the small bowel in the absence of a recognisable cause. Patients mainly present with a surgical abdomen and their management often proves to be a therapeutic challenge. Our series describes three such cases: the first patient presented with a tender left iliac fossa mass and rectal bleeding, the second with peritonitis and pneumoperitoneum, the third with severe acute colitis. All three patients needed urgent surgical intervention with further laparotomies due to recurrent ulceration, perforation and fistula formation in addition to intensive supportive measures such as inotropes and total parenteral nutrition. The importance and challenges of idiopathic chronic ulcerative enteritis are therefore discussed.