Drainage of a Bartholin Duct Cyst Video
Should the Bartholin gland become infected, it
will form a Bartholin abscess. In this case, the labia majora becomes
excruciatingly painful, red and swollen. Some of these will drain
spontaneously and this process may be hastened by warm moist dressings or
sitz baths. Others will require drainage. It is a relatively simple
procedure to drain Bartholin cysts or abscesses.
Incision and Drainage of the abscess gives
immediate relief. Watch this video for a
demonstration of this procedure on a Bartholin cyst:
Select a place for the incision. It should be
on the medial side of the cyst, relatively close to the hymeneal ring,
although if there is one area of obvious thinning of the epithelium, I’d
aim for the thinnest part, so long as it still medial and in the mucous
Give local anesthetic of 1% Lidocaine over the
Steady the cyst or abscess with one hand while
directing a scalpel into the center of the abscess.
Culture purulent drainage for gonorrhea and
chlamyia. Only infrequently will these cultures be positive, but often
enough to warrant your attention. Other commonly cultured organisms
include coliforms and strep.
If loculations are present within the abscess
cavity, break them up by inserting and then spreading a hemostat.
Antibiotic therapy is optional but usually
used, particularly if the patient is febrile, the abscess large, or the
skin is red or tender.
Simple incision and drainage of the abscess will
provide immediate relief and more likely than not, permanent cure. In a
significant minority of patients treated with simple I&D, the abscess or
cyst will re-occur. This happens because after healing, the surgical opening
into the cyst or abscess cavity seals over, resulting in isolation of the
Bartholin gland beneath the skin. For this reason, more aggressive surgical
treatment is sometimes used.
Packing the abscess cavity with gauze and
leaving a wick external to the cavity is not an effective technique with
Bartholin cysts and abscesses. Early in my surgical career, I used this
method a number of times and never had the packing remain in the cavity for
more than a few hours.
One commonly used, good technique to keep the
drainage tract open is the insertion of a "Word Catheter." A Word catheter
is a soft rubber tube with an inflatable tip. After drainage is established,
insert the tip of the Word catheter into the cavity and inflate the balloon
tip with a few cc of any physiologic liquid such as sterile saline or
lidocaine. The inflated balloon tip will keep the catheter from becoming
dislodged and the stalk of the catheter will help keep the drainage tract
open long enough for the cut skin edges to re-epithelialize to the inside of
the cyst. Essentially, this results in a new duct connecting the Bartholin
gland directly to the skin surface.
The stalk of the catheter is bent back and
inserted into the vagina, so it can be left in place for many days. Ideally,
it should be left for a few weeks, but it is irritating enough to the
patient that it may need to be removed after several days. Even this short
period of time is enough for it to be effective. Even with the Word
catheter, there may still be recurrences of the cyst or abscess, but they
are less frequent than with the simple I&D procedures.
Another way to accomplish the creation of a new
drainage tract is to "marsupialize" the cyst or abscess. After opening the
cyst, suture the squamous epithelial skin edge to the cuboidal epithelial
cyst wall. This allows the cut skin cell fibroblasts the opportunity to
spread down into the cyst, with creation of a new opening, allowing
secretions to escape.
This information is provided by
The Brookside Associates,
a private organization, not affiliated with any governmental agency. The
opinions presented here are those of the author and do not necessarily
represent the opinions of the Brookside Associates. For educational
simplicity, only one method is usually shown, but many alternative methods may give
satisfactory or superior results.
This information is provided solely
for educational purposes. The practice of medicine and surgery is regulated
by statute and restricted to licensed professionals and those in training
under supervision. Performing these procedures outside of that setting is a
bad idea, is not recommended, and may be illegal.
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