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

Diagnosis

• 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

DDX

1. Cysts of other glandular structures
2. Leiomyoma
3. Lipoma
4. Carcinoma
   1. Consider in older women who present w/ introital mass

Treatment

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

1. Word Catheter
   1. Inject local anesthetic
   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
   4. Insert Word catheter and inflate balloon w/ 2-4mL of water
   5. Tuck end of catheter into the vagina
   6. Catheter should remain in place for 4-6wk to avoid recurrence
2. Rubber Ring Catheter (Jacobi Ring): 7-cm length of an 8–French T tube threaded with a 20-cm length of 2-0 silk suture. Less cumbersome for the patient and less likely to fall out.
   1. Inject local anesthetic
   2. Stab incision is made on the mucosal surface
   3. Pass hemostat into abscess cavity to lyse adhesions, and tunnel to make indentation for second incision
   4. Grab one end of Jacobi ring and pull through abscess cavity
   5. Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)

Abx

1. Cefixime 400mg PO QD x7d + clindamycin 300mg PO QID x7d

Woundcare

1. Sitz bath x2 days
2. Abstain from vaginal intercourse
3. Refer to GYN if >40yr (might need biopsy to r/o CA) and recurrence (complete excision vs. marsupialization)

See Also

Incision and Drainage

Source

Tintinalli

Images obtained from AEJM artle