Background and the aim of the study: The presence of more than one primary tumor in the colon at time of presentation is diagnosed as colorectal synchronous neoplasias (SN) and the largest one is considered the index tumor. The aim of this study is to identify the magnitude of synchronous colorectal neoplasias and its relation to different variables as pattern of presentation, age, gender and histopathology in addition to evaluation of different methods of diagnosis in patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Patients and methods: This is a retrospective chart review study. The hospital records and the files of all patients diagnosed to have  colonic neoplasms were reviewed from January 2008 to August 2014. Results: The study involved 87 patients, 53 males and 34 females. Ten of the 87 patients (6 males and 4 females) had synchronous colonic neoplasms (11.5%). Intestinal obstruction was the presenting symptom in 4/10 patients (40%, Vs 35.6% in patient with single lesion), rectal bleeding in 4/10 patients (40%) and in 20% mass in right lower quadrant was the presenting symptom. In obstructed patients,  SN was diagnosed after examination of the operative specimen, however; intra-operative palpation detected multiple colonic polypi in one patient and intra-operative colonoscopy detected SN in another 2 patients. In the non obstructed patients preoperative colonoscopy and biopsy diagnosed multiple lesions in 5/6 of the patients (83.3%). Pre and intra- operative colonoscopy helped to guide accurately the extent of resection in 83.3% of non obstructed patients and in 75% of  obstructed patients respectively. Mean period of follow up was 3. 4±0.8 years. Conclusion: The incidence of SN is significantly higher in this study than that recorded in English literature, so a larger study involving all regions of Saudi Arabia is strongly recommended as the presence of SN worsens the prognosis entailing modification of the treatment options. Thorough pathological examination is mandatory of any doubtful colonic lesions, and the study verified the effectiveness of preoperative colonoscopy in patients with non obstructed colorectal cancer and intra-operative colonoscopy in obstructed patients for visualization and biopsy of these lesions.