Introduction: Suprapubic cystostomy is a common procedure in urology. Bowel perforation is the most serious and rare complication. This report highlights the first published case of massive lower gastrointestinal bleeding as a complication secondary to suprapubic cystostomy. Case presentation: A sixty-seven-year-old patient with benign prostate hyperplasia had a suprapubic catheter inserted under spinal anesthesia, during concurrent cystoscopy. It was functioning well after insertion. Twelve days later, he developed massive hematochezia. On examination, he was hemodynamically stable. There was a demonstrable right lower abdominal tenderness and the digital rectal examination revealed dark red blood. The suprapubic cystostomy was draining clear urine without leakage. Investigations revealed a hemoglobin 6 g/dL and normal INR. Two units of packed red blood cells were given. A colonoscopy showed a normal colon with blood coming from above the ileocecal valve area. Upper endoscopy was normal. A red blood cell scan revealed active bleeding at the terminal ileum. A computerized tomography scan of the abdomen with IV contrast showed that the suprapubic catheter had passed into terminal ileum causing active bleeding. Exploratory laparotomy confirmed the presence of suprapubic catheter passing to the terminal ileum. The suprapubic catheter was removed, the unhealthy bowel resected, and anastomosis performed with no immediate post-operative complications. Conclusion: This case determines the importance of keeping careful watch for possible bowel injury after cystostomy and should be considered a rare complication and cause of lower gastrointestinal bleeding.