Small bowel metastases from a primary lung carcinoma are rare. We report a case of a 59-year-old male with a primary small-cell lung carcinoma who developed anaemia and bowel symptoms. On colonoscopic examination he was found to have a tumour in the caecum near the ileocaecal valve, which was biopsied, revealing small neuroendocrine tumour cells. The patient then underwent systemic chemotherapy, which achieved a reduction in the size of the primary lung tumour and an improvement in his bowel symptoms. It is important that such a rare condition be recognised early as complicated intestinal metastases from a lung carcinoma can lead to high mortality rates and poor short-term outcome. With advances in chemotherapy and palliative care, patients with metastatic lung carcinoma can sometimes survive more than a year with reasonable quality of life.