Stercoral perforation is rare spontaneous rupture of the bowel due to fecal impaction. Most cases of stercoral perforation have been reported in elderly patients with preceding constipation and the colon was the most common site of perforation. We describe the process of diagnosis and treatment of a stercoral perforation of the distal ileum in a very low birth weight male infant born in preterm. More studies regarding the development of fecal impaction after normal excretion of meconium in very low birth weight neonates are needed.