Stercoral colitis, although rare, remains a significant cause of acute colonic inflammation. It is characterized by the presence of fecaloma leading to fecal impaction and subsequent mucosal injury, ultimately resulting in colonic wall inflammation. This condition primarily affects elderly patients with chronic constipation and is associated with significant morbidity and mortality if not recognized and managed promptly.Given its rarity and varied presentation, stercoral colitis often poses a diagnostic challenge. The clinical manifestations can mimic other colonic pathologies, such as diverticulitis, ischemic colitis, and inflammatory bowel disease, further contributing to diagnostic dilemmas. However, an astute clinician, armed with a high index of suspicion and the aid of advanced imaging techniques, can establish the correct diagnosis and initiate timely management.In this case report, we present a challenging case of stercoral colitis in an elderly patient with a history of chronic constipation. The aim of this report is to enhance awareness and understanding of this underdiagnosed condition among healthcare providers. Additionally, we discuss the clinical presentation, diagnostic workup, and therapeutic interventions employed to manage this formidable gastrointestinal entity.