Distant metastasis of colorectal cancer (CRC) to unusual sites, like small bowel, kidney, thyroid many years after resection of the primary tumor is rare but has been reported. A 71-year old female with a history of Stage IIIb CRC status post resection 2 years ago presented with worsening dyspnea, fatigue and post-prandial lower abdominal pain for 2 weeks. Her other medical conditions include coronary artery disease, pulmonary hypertension and atrial fibrillation on anticoagulation therapy. She denied any nausea, vomiting, bright red blood per rectum, NSAID's use or epigastric pain. Her abdominal exam was benign except for dark stool on rectal exam. Labs showed iron deficiency anemia and positive fecal occult blood. She underwent capsule endoscopy which showed a ulcerated area in the proximal small bowel with oozing blood and irregular mucosa. Eventually, she underwent single balloon enteroscopy which showed an ulcerated, friable mass in the mid-distal jejunum. Biopsies showed moderately differentiated adenocarcinoma and positive anti-CK 20, similar to her primary sigmoid lesion, confirming the diagnosis of metastasis from CRC. The incidence of CRC metastases to the small bowel is relatively rare, about 2.8-8.2%. The most common site is ileum, followed by jejunum. A significant lag time of 1.3-7 years, from the initial diagnosis of colorectal cancer to the onset of symptomatic small bowel metastasis, has been reported. The routes of metastasis to the small intestine include hematogenous, peritoneal or intestinal metastasis. The major route from CRC is, disseminated metastasis associated with peritonitis carcinomatosa. Patients may present with symptoms such as occult bleeding, intestinal obstruction, or perforation. The diagnosis is often made on a small bowel series or CT. However, neither can differentiate a primary from a metastatic small bowel cancer. Radical surgical resection of such late metastasis is reportedly associated with a good quality of life but postoperative complication rates are high, about 80% and survival is short (2-15 months), although survival up to 11 years has been reported. Our case highlights the late occurrence of CRC metastases at unusual sites like small bowel, several years after the resection of the primary. It should be suspected in any patient with occult GI bleeding and history of CRC. Diagnosis is based on capsule endoscopy for tumor localization and balloon-assisted enteroscopy for confirmation.