Stercoral colitis complicated by ischemic colitis is rare. Current literature has focused on the radiographic characteristics of stercoral colitis and management of bowel perforation resulting from complicated stercoral colitis. This case report describes possible challenges in diagnosing and managing stercoral colitis complicated by ischemic colitis. We present a case of stercoral colitis complicated by ischemic colitis in a 28-year-old woman who presented with lower gastrointestinal bleeding.