Stercoral ulceration is the loss of bowel integrity from the pressure effects of inspissated feces. The lesion usually occurs in constipated, bedridden patients and presents as an isolated lesion in the rectosigmoid area. Because of associated diseases in the population at risk, perforation and hemorrhage, the principal complications, result in a mortality exceeding 50 per cent. The diagnosis of perforated stercoral ulceration should be considered in any patient with a long-standing history of constipation who presents with acute abdominal pain and clinical findings consistent with perforation of a hollow viscus. Early celiotomy with vigorous debridement and irrigation of the peritoneal cavity and either exteriorization or resection with proximal colostomy is the treatment of choice. Since constipation and colonic dysfunction are more common in the older patient, as the mean age of the population increases, the surgeon may encounter this problem more often. Four patients with stercoral ulceration managed at the Medical College of Virginia Hospitals are added to the 53 patients previously reported in the literature.