Bartholin gland abscess
(Redirected from Bartholin Gland Abscess)
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
- Most common in young, adult women (20-30 years old)
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)
Acute Pelvic Pain
Gynecologic/Obstetric
- Pregnancy-related
- Ectopic Pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
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 (fully inflated it is not much larger than 1cm)
- Insert Word catheter and inflate balloon with 2-4mL of water. The safest way to do this is with a blunt needle tip (just long enough if pressure applied); the kit comes with a long 22-27 gauge needle but if using this be careful
- Tuck end of catheter into the vagina
- Catheter should remain in place for 4-6wk to avoid recurrence
Jacobi rocks
Rubber Ring Catheter (Jacobi Ring)[2][3]

Jacobi ring catheter[4]

Jacobi ring catheter placement technique.[5]
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
No randomized trials, general approach from expert opinion
Limit antibiotic treatment to patients with:
- Recurrent Bartholin Abscess
- High risk of complications
- Surrounding Cellulitis, immunocompromise, pregnancy
- Systemic Infection (eg, fever, chills)
Regimens:
- Bactrim 1 DS PO BID + Amoxicillin-clavulanate: 875mg PO BID
- 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
External Links
Videos
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References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ 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
- ↑ Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. American Journal of Emergency Medicine. May 2005. 23(3);414-415 DOI:https://doi.org/10.1016/j.ajem.2005.02.033
- ↑ Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. American Journal of Emergency Medicine. May 2005. 23(3);414-415 DOI:https://doi.org/10.1016/j.ajem.2005.02.033