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The Journal of Emergency Medicine, Vol. 36, No. 4, pp.

388 –390, 2009


Copyright © 2009 Elsevier Inc.
Printed in the USA. All rights reserved
0736-4679/09 $–see front matter

doi:10.1016/j.jemermed.2008.05.019

Technical
Tips

NOVEL TECHNIQUE FOR MANAGEMENT OF BARTHOLIN GLAND CYSTS


AND ABSCESSES
Vitaly A. Kushnir, MD and Claudia Mosquera, MD

Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, Newark, New Jersey
Reprint Address: Vitaly A. Kushnir, MD, Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, MSB
E-506, 185 South Orange Avenue, Newark, NJ 07101-1709

e Abstract—Background: Definitive methods for treatment alization, application of silver nitrate to the abscess cav-
of a Bartholin cyst and abscess include placement of a Word ity, curettage and suture, and surgical excision (1–7).
catheter, marsupialization, application of silver nitrate, and Placement of a Word catheter is the most frequently
surgical excision. Placement of a Word catheter is the most employed technique for office and emergency depart-
frequently employed technique for office and emergency de-
ment (ED) management (2,3). The advantages of the
partment (ED) management. However, many institutions do
not have the Word catheter available; in addition, the catheter
Word catheter include: simplicity, in-office placement,
has a tendency to dislodge before epithelialization, leading to and resumption of intercourse after placement. However,
recurrence of the cyst. Objective: We have developed a simple in our clinical experience, lack of availability of the
technique for management of Bartholin gland abscess or cyst Word catheter at many institutions, and its tendency to
using readily available materials. This technique involves us- dislodge, limit its clinical application. We have devel-
ing a small loop of plastic tubing, which is secured to prevent oped a simple technique for management of Bartholin
expulsion before epithelialization of a drainage tract. Case gland abscess or cyst using readily available materials.
Report: A 25-year-old woman presented to the ED with a This technique employs a loop of tubing to allow com-
Bartholin gland abscess. After administration of local anes- plete epithelialization of a drainage tract while the device
thetic, a loop of tubing was placed, allowing for drainage of the is secured in place to prevent expulsion.
abscess. The patient was discharged home with a course of
oral antibiotics. At 3-week follow-up, the Bartholin gland
abscess was found to be healed; the device was removed
without difficulty, leaving two drainage tracts. Conclusion: CASE REPORT
This technique may be used as an alternative to placement of
a Word catheter for management of Bartholin gland abscess A 25-year-old woman, G6P3033, presented to the ED
or cyst. © 2009 Elsevier Inc. complaining of a painful vulvar mass of 2 days duration.
She denied any medical or surgical history, previous
e Keywords—Bartholin gland abscess; cyst; Word cathe-
sexually transmitted diseases, and gynecological prob-
ter; vulva
lems. The patient was found to be afebrile; the pelvic
examination revealed a tender 6-cm right vestibular mass
INTRODUCTION with associated vulvar erythema and edema. Bartholin
gland abscess was diagnosed and definitive methods of
Definitive methods for treatment of a Bartholin cyst and treatment were reviewed with the patient (1–7). The
abscess include placement of a Word catheter, marsupi- patient elected to undergo placement of a Word catheter;

RECEIVED: 23 March 2008; FINAL SUBMISSION RECEIVED: 4 May 2008;


ACCEPTED: 7 May 2008
388
Bartholin Gland Cysts and Abscesses 389

however, our institution (like many others) does not have expulsion. The device is left in place until epithelializa-
these catheters available. We proposed placing a device tion occurs 3 to 5 weeks later. At that point, the suture is
similar to the Word catheter that would permit complete cut and the device is removed.
epithelialization of a drainage tract. In the ED, the ab- The equipment used for this procedure includes the
scess cavity was drained and a loop of tubing was placed following: sterile gloves, iodine solution, lidocaine 1%
using the technique described below. The patient re- solution, 30-gauge (1-inch) needle with 5-mL syringe for
ceived broad-spectrum antibiotics and was instructed to injecting lidocaine, small forceps for grasping cyst wall,
undergo pelvic rest and to take sitz baths at home. No. 11 scalpel, hemostat to break up loculations, scis-
When the patient returned for a 3-week follow-up, the sors, and 5-cm piece of butterfly vacutainer tubing with
Bartholin gland abscess was found to be healed and the vicryl suture threaded through the lumen.
device was removed without difficulty, leaving two
drainage tracts.
DISCUSSION

Procedure Description Because simple incision and drainage of a Bartholin


gland abscess carries a high risk of recurrence, tech-
Our technique is performed using sterile preparation and niques that pack the cavity or leave a catheter that allows
administration of a local anesthetic. The wall of the cyst for formation of a drainage track are widely employed
or abscess is grasped with a small forceps, and a No. 11 (8). The technique of using a loop of tubing has several
blade is used to make a 2-mm stab incision into the cyst advantages over placement of a Word catheter, including
or abscess. It is important to grasp the cyst wall before comparable ease of placement, availability of the equip-
the incision is made; otherwise, the cyst may collapse, ment in most institutions and offices, and, in addition, the
and a false tract be created. The incision should be within loop device is less likely to dislodge. The disadvantages
the introitus external to the hymenal ring in the area of include need for pelvic rest and relative discomfort of a
the duct orifice. After the initial incision is made, a foreign body. Furthermore, the loop device creates two
hemostat is used to break up loculations. The hemostat is drainage tracts, in comparison to one tract created with
then advanced 2 cm superior to the initial incision and a the Word catheter. The majority of Bartholin gland ab-
second 2-mm stab incision is made using a No. 11 blade. scesses involve the anaerobic and aerobic bacteria nor-
At this point, a 5-cm piece of tubing from a butterfly mally found in the vagina; however, sexually transmitted
vacutainer with a piece of vicryl suture threaded through infections with Neisseria gonorrhoeae and Chlamydia
the lumen is grasped and pulled through the second stab trachomatis are common. Antibiotics are indicated if
incision and out the first, using the hemostat. The vicryl there are significant surrounding cellulites; appropriate
suture is then tied to secure the device in place, creating coverage for Chlamydia and gonorrhea may be admin-
a loop (Figure 1), and the ends of the suture are trimmed. istered pending results of cultures (8 –10). This technique
This allows a portion of the device to remain in the should not be used in patients who are at risk for Bar-
abscess cavity while the device is secured to prevent tholin gland cancer (11,12). A randomized controlled
trial is needed to evaluate the clinical utility of this
technique in comparison to the Word catheter.

CONCLUSION

This technique may be used as an alternative to place-


ment of a Word catheter for management of Bartholin
gland abscess or cyst.

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