Background: Untreated constipation can lead to fecaloma loading in colon, stercoral colonic perforation and subsequently stercoral peritonitis. Stercolar peritonitis is relatively uncommon presentation with a grave prognosis. Case Presentation: We recently managed a 46-year-old lady known HIV- infected who had a long standing history of constipation. She presented to us with history of acute generalized abdominal pain, fever, vomiting and signs of peritonism for four days. Abdominal radiography showed colonic fecal loading and pneumoperitoneum while abdominal ultrasound demonstrated free fluid in the peritoneal cavity. She underwent emergency exploratory laparotomy in which, we found a perforation at rectosigmoid junction with protruded fecaloma and significant feco-purulent peritoneal fluid. Evacuation of fecolomas, resection of perforated bowel and Hartmann’s procedure was done. The patient was sent to a high dependent unit with standard post-operative orders. She unfortunately demised on day 2 post-operatively due to intractable sepsis. Conclusion: Fecal impactions should be promptly treated to avoid fatal complications like stercoral peritonitis. Judicious selection of patients with underlying risk conditions like HIV/AIDS for referral and expert definitive management can warrant relatively favorable surgical outcome.