Fecaliths and stercoraceous ulcerations are well-known complications of chronic constipation. The authors present the case of a double anal canal in an elderly man. This anorectal fistula (complex anal fistula) developed as a complication of an impacted rectal fecalith with resultant stercoraceous ulceration. Eventually, a persistent epithelialized canal developed and was demonstrated at double-contrast barium enema examination. The patient remained continent at all times.