We herein report a case of megacolon with fecaloma in an 83-year-old man who presented with constipation, no intestinal occlusion, and a left hydroureteronephrosis, with A.S.A. 4. The patient asymptomatic, was treated Primariely with laxatives. During the conservative therapy the patient presented an abrupt abdominal distension with a bowel obstruction and abdominal compartment syndrome. After the laparotopy and a Hartmann left colon resection the patient died for cardiovascular and metabolic complications. The aim of this report is to give a brief review of this entity and discuss the treatment options for these cases.