Vital ileoscopy: a step beyond colonoscopy in positive fecal occult blood test

Fecal occult blood testing (FOBT) is a key tool in colorectal cancer screening, typically followed by colonoscopy after a positive result. However, in patients with normal colonoscopy findings, further investigation may be warranted. We present the case of a 54-year-old asymptomatic male with a positive FOBT and normal colonoscopy, where terminal ileoscopy revealed a subepithelial ulcerated lesion causing significant luminal obstruction. Histological and immunohistochemical analyses confirmed an aggressive large B-cell non-Hodgkin lymphoma. Following surgical resection and pathological confirmation, the patient was referred for chemotherapy. This case underscores the diagnostic value of terminal ileoscopy in detecting occult pathology in patients with unexplained positive FOBT, emphasizing its role as a vital extension of standard colonoscopic evaluation.