This 46 year old lady had reported pruritus ani and abdominal discomfort for over a year. Colonoscopy revealed a long moving tapeworm, Diphyllobothrium latum (fish tapeworm), located in the terminal ileum and extending gracefully to the sigmoid colon. Diphyllobothrium latum tends to infect humans through the consumption of infected undercooked or raw fish. The patient was successfully treated with a single dose of praziquantel, with mebendazole -albendazole being an alternative treatment.