Bartholins Gland Abscess or Cyst

The Bartholin's glands are located between the hymen and labia minora bilaterally at the 4 and 8 o'clock positions. Cysts occur when the duct is blocked from trauma or edema, and abscesses occur when retained secretions become infected. Abscesses are frequently surrounded by some level of cellu-litis of the tissues and can be very painful and indurated. Treatment relies on drainage of the cyst or abscess, treatment of any associated cellulitis with oral antibiotics if indicated, and creation of a track that eventually epithelializes, allowing normal gland drainage and reduced recurrence.

For drainage, the patient is placed in the dorsal lithotomy position and the cyst or abscess identified in the introitus in

Figure 28-18 A, Paragard T380A is displayed above Mirena. Note that both intrauterine devices have IUD arms extended. B, End of Paragard T380A is displayed above end of Mirena with both IUDs having arms fully retracted in opposite directions and ready for placement.

the area of maximal swelling and fluctuance. Topical anesthesia can be used on the surface or a local anesthetic injected under the mass for patient comfort. The cyst wall is grasped through the mucosal surface with two clamps 3 to 5 mm apart and a #11 blade used to puncture and open the site. The contained fluid is removed and cultured. The cyst can be packed with gauze, but recurrence is frequent. To prevent recurrence, a Word catheter can be placed into the open cyst or abscess. The catheter is a latex stem attached to an inflatable balloon. The catheter is inserted into the incision between the clamps, with care taken to place it in the center of the cyst wall. The balloon is then filled with 2 to 3 mL of normal saline and left in place for 4 to 6 weeks until epithelialization of the track occurs. The catheter can then be removed. If the incision was done inside the hymen ring, the catheter end can be tucked into the vagina for comfort during the healing process. (See Tuggy Video: Bartholin's Cyst Word Catheter Placement.)

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