Colorectal carcinoma (CRC) constitutes 3% of all cancers among Egyptian patients. Tc-99m (V) DMSA has several advantages over other tumor imaging radiotracers being cheap, readily available, easily prepared, with superior physical properties and not excreted in the intestine.Purpose: The aim of this study is to evaluate the role of Tc-99m (V) DMSA scintigraphy in the assessment of CRC as well as inflammatory bowel disease (IBD).Patients and methods: The current study included 3 groups of patients Group (A) included 50 patients with a known gross loco-regional CRC (22 rectal, 28 colonic); their mean of age was 51.4 years. Group (B) included 36 patients, who had done complete excision of their primary tumor with safety margin; their mean of age was 45 years. Group (C) included 12 female patients having clinically and pathologically proven IBD; their mean of age was 32 years. All patients had done abdomino-pelvic US, CT and Tc-99m (V) DMSA whole body scan with early (post 2 hours) and late (post 4 hours) static spot views for abdomen and pelvis as well as early and late quantitative lesion/non-lesion (L/NL) ratios.Results: Tc-99m (V) DMSA had a 100% sensitivity and NPV , 94% PPV 70% specificity and 92% accuracy to localize gross active local residue and/or recurrence with overall L/NL ratios were 2±0.5 and 2.6±0.9 in early and late images respectively. The sensitivity to detect lymph node and liver metastases was low with planar images being 8% and 12% respectively. Significant positive correlation was found between degree of Tc-99m (V) DMSA uptake and pathologic grade as well as Dukes' stage of CRC. Tc-99m (V) DMSA showed positive uptake in 3/12 cases with IBD with overall mean L/NL ratio was 1.4±0.3Conclusion: Tc-99m (V) DMSA; although non-specific; but it provides high sensitivity for localization of metabolically active local gross, residual and recurrent colorectal carcinoma lesions.