An obese, previously healthy, 10-year-old boy presented with acute respiratory distress, chest, and abdominal pain. He was hypoxic and dyspneic in the emergency room. The abdomen was distended and tender, and the rectum was full of hard stool. Following catharsis, he made a complete recovery with resolution of all clinical signs. A review of the literature reveals that acute constipation as a cause of hypoxia and respiratory distress has been recognized, but has rarely been reported. We believe that this is a common phenomenon but probably infrequently recognized.