Hydronephrosis and ureteral obstruction are rare sequelae of Crohn’s disease. Chronic obstruction can ultimately lead to dysfunction of the affected kidney, and atypical presenting symptoms create pitfalls in diagnosis. Few reviews in the literature focus on this process and are limited to isolated case reports and case reviews. We performed a PubMed search using such terms as “Hydronephrosis” AND “Crohn’s disease” AND/OR “ureteral obstruction.” References from selected papers were reviewed for relevance and used for information-gathering as well. Ureteral obstruction most commonly occurs on the right side, due to ileal involvement. Clinical diagnosis is difficult, as symptoms are notably not genitourinary in origin; rather they are more musculoskeletal in nature. Treatment centers on disease control and temporary drainage of the affected kidney. Though rare, hydronephrosis and ureteral obstruction may develop as a result of inflammatory bowel disease. Due to atypical presenting symptoms, a high clinical suspicion is needed to affirm the diagnosis and ensure proper treatment.