Background <p>Intussusception of the blind ileal stump is an extremely rare late complication of Scopinaro biliopancreatic diversion. Diagnosis is challenging because symptoms may be intermittent and radiological imaging frequently inconclusive.</p> Case presentation <p>A 58-year-old woman presented several years after undergoing Scopinaro biliopancreatic diversion with recurrent abdominal pain and vomiting. Repeated imaging showed no obstruction. Upper gastrointestinal endoscopy revealed intussusception of an elongated blind ileal stump prolapsing into the efferent limb. Surgical exploration confirmed a 12-cm elongated stump acting as the lead point. Resection and anastomotic revision were successfully performed, with complete symptom resolution at 12 months.</p> Conclusions <p>Endoscopy can play a decisive diagnostic role in patients with intermittent symptoms and negative imaging. An excessively long blind ileal stump is a potentially modifiable risk factor for blind ileal stump intussusception. To our knowledge, this is the first reported case of blind ileal stump intussusception after Scopinaro biliopancreatic diversion diagnosed dynamically through real-time endoscopy, demonstrating that endoscopy may be decisive when imaging is inconclusive.</p>