Indications for intraoperative enteroscopy (IOE) have decreased in recent years due to the development of imaging techniques, video capsule endoscopy (VCE), and device-assisted enteroscopy (DAE), providing a complete evaluation of the small bowel. Moreover, the classic IOE with laparotomy-enterotomy access is gradually being replaced by laparoscopically assisted DAE, primarily in elective surgery. Nevertheless, IOE remains an important method for assessing small bowel diseases in carefully selected patients and can detect new and additional lesions even after a thorough preoperative examination of the patient. IOE plays a crucial role in situations where less invasive interventions do not allow to yield a complete diagnosis or to safely perform endoscopic therapy. IOE is also useful for guiding therapy in preoperatively detected lesions and can change the management tactics of a significant part of patients.