A 47 year old man was admitted to hospital with abdominal pain, constipation and extreme abdominal distension. The patient did not have a regular bowel movement for the last two years of his life. He had been using laxatives, enema and went through manual removal of fecal impaction for the last 20 years of his life. At the age of 1, he underwent anal atresia surgery and Hirschsprung's disease (HD) was diagnosed at that time. The abdominal CT scan revealed massive fecal material in dilated colon and visible compressions of nearby structures. Medical consilium decided that the patient should undergo surgery, subtotal colectomy and unipolar colostomy. During the operation 21 kg feces was removed. The quality of life of patient improved significantly. Colostomy gave better results than treatment with laxatives for 20 years.