A problem frequently encountered in the management of the patient with an ileostomy or colostomy is excoriation of the skin around the fistula. The more prevalent use of bowel exteriorization as a technic in surgery of the bowel in casualties of "total warfare" has made this a problem of war surgery. In addition, the frequent establishment of bowel fistulas as procedures in various stages accompanying resection of segments of intestine for carcinoma or colitis has made the problem an important one in civilian practice.
The prime cause of the skin erosion in the vicinity of an intestinal fistula is believed to be in most cases the digestive action of the draining intestinal fluids. The proteolytic enzymes responsible are probably mainly of pancreatic origin; thus the contents from the duodenum have a more corrosive action than the contents from the ileum, and the contents from the colon are least corrosive. For