Wernicke’s encephalopathy (WE) is a serious neurological disorder that can be fatal if not properly treated. In this current paper, I present the case of a 51-year-old male with a perivesical fistula between a presacral abscess and the rectus abdominis muscle. He received total parenteral nutrition therapy during a fasting period because of small bowel obstruction and later developed WE. The patient’s WE-related symptoms improved following rapid treatment with high doses of thiamine.