Statement of Clinical Problem: A 65 year old female patient with history of Crohn's disease and ileostomy for 40 years presented to our wound center after developing peristomal skin breakdown. Other than Crohn's disease, patients health history is unremarkable. It was discovered patient had a ten pound weight gain over past 2 years and had no regular follow up with a colorectal surgeon or WOC nurse for fifteen years. Patient was changing her pouch daily for the past six months due to the development of multiple small and painful peristomal wounds secondary to constant leakage. Description of Past Management: Patient has been wearing the same 2-piece re-usable system for the past 20 years and was resistant to change. Current Clinical Approach: Our first challenge was to convince the patient she needed to change her pouching system to a disposable 1-piece system with light convexity. Due to the patients large abdomen and inability to see the wounds patients spouse was instructed on wound care and pouch changes. The peristomal wounds were treated with silver hydrofiber dressing. A washer was applied to pouch and then to the patient using a belt. Initially, pouch change and wound care was completed every other day. As the wounds began to heal and pain decreased we were able to increase wear time to every 3 to 4 days. Within 3 months the patients wounds were healed and patient had returned for follow up with her colorectal surgeon. Conclusion: Individuals with long term ostomy needs to have regular periodic re-assessment of stoma for proper fitting and adjustments of pouching system. We now recommend follow up every 2 years with the WOC nurse and colorectal surgeon.