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

Bartholin gland cyst (non-infected) of right labia at 7-8 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)
• 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
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome

Evaluation

• Usually clinical diagnosis

Management

Incision and Drainage

I&D only perform once abscess is well-defined, walled-off structure

Word Catheter

Uninflated word catheter

Word catheter inflated with approximately 2 ml of saline (blunt needle preferred for injection)

1. Inject local anesthetics
2. Stab incision is made on the mucosal surface
3. 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)
4. 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
5. Tuck end of catheter into the vagina
6. Catheter should remain in place for 4-6wk to avoid recurrence

Jacobi rocks

Rubber Ring Catheter (Jacobi Ring)

Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess

1. 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.
2. Inject local anesthetic
3. Stab incision is made on the mucosal surface
4. Pass hemostat into abscess cavity to lyse adhesions, and tunnel to make indentation for second incision
5. Grab one end of Jacobi ring and pull through abscess cavity
6. 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

• Incision and Drainage

External Links

• Merck Manual - Bartholin Gland Cyst
• First10EM - What's the word on Word Catheters?

Videos

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