Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for fewer than 3% of laparotomies for intestinal obstruction. Patients with long-standing Crohn's disease have an increased risk of developing gallstone disease. However, gallstone ileus is not common in these patients. We report the case of a 70-year-old female with Crohn's disease who presented with gallstone ileus, and present a review of the literature. We discuss the association between gallstone ileus and Crohn's disease, and the treatment options for these patients. We emphasize the importance of including gallstone ileus in the differential diagnosis in patients presenting with intestinal obstruction, especially patients with long-standing Crohn's disease. We advocate the early utilization of computerized tomography to confirm the diagnosis, and prompt early surgical intervention.