The aim of this study was to report the clinical characteristics and outcomes of gastrointestinal metastasis from lung cancer, with special emphasis on a long-term survivor after surgery. We retrospectively reviewed all patients diagnosed with lung cancer between 2000 and 2007 at a tertiary referral center for cancer. Gastrointestinal metastases were detected in 10 (0.19%) of 5,239 lung cancer patients. Small bowel metastases occurred in one-half of the patients, making it the most common metastatic site. One patient underwent emergency surgery because of an intestinal perforation. Although a perforation developed only in this patient, surgical intervention was required for five other patients to relieve intestinal obstruction or control bleeding. The prognosis was poor, with a median survival of 96.5 days after diagnosis. However, one patient remains alive >5 years post-operatively, without a recurrence, suggesting that surgical resection is an option for cure in properly selected patients. Physicians should be familiar with unique features of lung cancer with metastasis to the gastrointestinal tract so as to render early and optimal management.