Bartholin gland abscess: Difference between revisions
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==Background== | ==Background== | ||
*Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions | *Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions | ||
*A cyst does not need to be present for an abscess to develop | *A cyst does not need to be present for an [[abscess]] to develop | ||
==Clinical Features== | ==Clinical Features== | ||
*Mass in posterior introitus near 4 o'clock or 8 o'clock position | *Mass in posterior introitus near 4 o'clock or 8 o'clock position | ||
**May develop over days or longer time (if preceded by cyst) | **May develop over days or longer time (if preceded by cyst) | ||
*Systemic symptoms (e.g. fever/chills) are rarely present | *Systemic symptoms (e.g. [[fever]]/chills) are rarely present | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
===Incision and Drainage=== | ===[[I&D|Incision and Drainage]]=== | ||
''I&D only perform once abscess is well-defined, walled-off structure'' | ''I&D only perform once [[abscess]] is well-defined, walled-off structure'' | ||
====Word Catheter==== | ====Word Catheter==== | ||
#Inject local | #Inject [[local anesthetics]] | ||
#Stab incision is made on the mucosal surface | #Stab incision is made on the mucosal surface | ||
#Extend incision for several mm but not so many that the Word catheter will fall out | #Extend incision for several mm but not so many that the Word catheter will fall out | ||
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#Tuck end of catheter into the vagina | #Tuck end of catheter into the vagina | ||
#Catheter should remain in place for 4-6wk to avoid recurrence | #Catheter should remain in place for 4-6wk to avoid recurrence | ||
====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>==== | ====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>==== | ||
[[File:Jacobi.jpg|thumb|<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]] | [[File:Jacobi.jpg|thumb|<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]] | ||
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#Inject local anesthetic | #Inject local anesthetic | ||
#Stab incision is made on the mucosal surface | #Stab incision is made on the mucosal surface | ||
#Pass hemostat into abscess cavity to lyse adhesions, and tunnel to make indentation for second incision | #Pass hemostat into [[abscess]] cavity to lyse adhesions, and tunnel to make indentation for second incision | ||
#Grab one end of Jacobi ring and pull through abscess cavity | #Grab one end of Jacobi ring and pull through [[abscess]] cavity | ||
#Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk) | #Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk) | ||
===Antibiotics=== | ===Antibiotics=== | ||
*Cefixime 400mg PO QD x7d + [[clindamycin]] 300mg PO QID x7d | *[[Cefixime]] 400mg PO QD x7d + [[clindamycin]] 300mg PO QID x7d | ||
===Wound Care=== | ===Wound Care=== |
Revision as of 13:40, 7 October 2019
Background
- Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions
- A cyst does not need to be present for an abscess to develop
Clinical Features
- Mass in posterior introitus near 4 o'clock or 8 o'clock position
- May develop over days or longer time (if preceded by cyst)
- Systemic symptoms (e.g. fever/chills) are rarely present
Differential Diagnosis
- Cysts of other glandular structures
- Leiomyoma
- Lipoma
- Carcinoma (consider in older women who present with introital mass)
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Evaluation
- Usually clinical diagnosis
Management
Incision and Drainage
I&D only perform once abscess is well-defined, walled-off structure
Word Catheter
- Inject local anesthetics
- Stab incision is made on the mucosal surface
- Extend incision for several mm but not so many that the Word catheter will fall out
- Insert Word catheter and inflate balloon with 2-4mL of water
- Tuck end of catheter into the vagina
- Catheter should remain in place for 4-6wk to avoid recurrence
Rubber Ring Catheter (Jacobi Ring)[1][2]
Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess
- Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.
- Inject local anesthetic
- Stab incision is made on the mucosal surface
- Pass hemostat into abscess cavity to lyse adhesions, and tunnel to make indentation for second incision
- Grab one end of Jacobi ring and pull through abscess cavity
- Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)
Antibiotics
- Cefixime 400mg PO QD x7d + clindamycin 300mg PO QID x7d
Wound Care
- Sitz bath x2 days
- Abstain from vaginal intercourse
- Refer to GYN if >40yr (might need biopsy to rule out CA) and recurrence (complete excision vs. marsupialization)
Disposition
- Usually outpatient management
See Also
References
- ↑ Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5
- ↑ Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90
- ↑ AEJM artle
- ↑ AEJM artle