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Blockage of the mesenteric artery typically causes necrosis to the colon, requiring extensive surgical resection. In severe cases, the necrosis requires removal of the entire colon, creating numerous problems for the WOC nurse when pouching the opening created for effluent. This article describes the management of a draining duodenal fistula in a middle-aged woman, who survived surgery for a blocked mesenteric artery that necessitated the removal of the majority of the small and large intestine. Nutrition, skin management, and pouch options are described over a number of months as the fistula evolved and a stoma was created.