Background: There is conflicting data to support routine terminal intubation and biopsies during colonoscopy. The clinical result may be predicted by the histological results of biopsies performed during terminal intubation. Aim of this work: to determine the utility of routine terminal ileoscopy (TI) and biopsy during colonoscopy in Hepatology, Gastroenterology and Infectious Diseases department at Benha University Hospitals, Benha, Egypt. Methods: This study was conducted on (140) consenting patients presented to colonoscopy unit, Hepatology, Gastroenterology and Infectious Diseases department at Benha University Hospitals, because of one or more of the following complaints: Unexplained iron deficiency anemia, right lower quadrant (RLQ) abdominal pain, bleeding per rectum, positive occult blood in stool, chronic diarrhea and chronic constipation. Colonoscopy with routine terminal ileoscopy and biopsy was done for all patients. Results: 14/140 (10%) patients had either macroscopic 6/14 (42.9%) or microscopic 8/14 (57.1%) abnormalities of the terminal ileum while 3/14 (21.4%) patients had both. These were Crohn's disease (4/8), Behcet's disease (1/8), Tuberculosis (1/8), ileal villous atrophy (1/8) and nonspecific ileitis (1/8). 5/8 with macroscopically normal ileum had significant ileal abnormality: Crohn's disease (2/5), Tuberculosis (1/5), ileal villous atrophy (1/5) and nonspecific ileitis (1/5). Conclusion: Terminal ileoscopy and histopathological ileal examination improves the diagnostic yield of colonoscopy and influences management even in endoscopically normal ileal findings.