Ileocecal lipohyperplasia is a relatively uncommon pathological entity characterised by submucosal infiltration of adipose tissue in the ileocecal valve (ICV). The majority of patients are asymptomatic, whereas, others present with serious complications. We report a 45-year-old man who presented with recurrent episodes of melena with secondary sideropenic anaemia for 6 years. Extensive radiological and endoscopic workup failed to detect the source of bleeding. During his last admission for abdominal pain, contrast-enhanced CT scan revealed a fatty mass at the ICV. The patient underwent limited right hemicolectomy, and histology confirmed ileocecal lipohyperplasia. The patient remained well 18 months later. This case highlights the difficulties encountered by clinicians in diagnosing this unusual colonic pathology.