Escherichia coli O157:H7 is most commonly linked to hemorrhagic colitis and the hemolytic uremic syndrome. Diagnostic ultrasound was used to demonstrate terminal ileum abnormalities suggestive of bacterial ileocecitis, a recently described entity that resembles acute appendicitis, in a patient whose stool culture yielded E. coli O157:H7. This case extends the spectrum of disease caused by E. coli O157:H7 and expands the number of organisms that can cause bacterial ileocecitis.