Bartholin’s Gland Cyst/Abscess Drainage

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Chapter 229 Bartholin’s Gland Cyst/Abscess Drainage

DESCRIPTION

Bartholin’s gland cyst/abscess drainage is acute drainage of symptomatic cystic dilation of the Bartholin gland.

INDICATIONS

Symptomatic cystic dilation or abscess of the Bartholin gland. Asymptomatic cysts in women younger than age 40 do not need treatment. (In patients older than age 40, biopsy is indicated.) Mild Bartholin’s gland infections may also be treated with broad-spectrum antibiotics and frequent warm sitz baths.

CONTRAINDICATIONS

Incomplete evaluation of the vulvar lesion, bleeding diathesis, known or suspected allergy to agents used (e.g., latex, iodine).

TECHNIQUE

After appropriate informed consent has been obtained from the patient, the skin of the vulva is disinfected. When an acute abscess is to be drained, the exquisite tenderness that is usually present dictates that this is done gently; pain relief is best obtained through the use of an analgesic or skin-freezing spray. This technique may be used for nonacute Bartholin’s cysts; local anesthesia using local or field infiltration is also appropriate. Abscesses should be incised at the point of least thickness overlying the mass (where the abscess is “pointing”). A vertical or “stab” incision is made, generally resulting in the abrupt release of purulent material. (Despite the apparent purulent character of the drained material, culture is generally of little utility in the management of these cases.) The size of this incision need only be on the order of 1 or 2 cm; sutures are generally not required. The abscess cavity may be gently irrigated with normal saline using a 10-mL syringe. A Word catheter should then be placed through the incision and inflated with a few milliliters of saline. As an alternative, iodoform gauze packing may be placed within the cavity with a 2- to 3-cm “tail” left outside the incision to facilitate eventual removal. Unless cellulitis is present, antibiotic therapy is not required.

When the cyst is not acutely inflamed, it should be stabilized and tensed by gentle finger pressure applied on either side of the affected labium, below the cyst. Incision in this case should be made within the hymeneal ring whenever possible. Incision length should be similar to that used for acute cases, and a Word catheter or iodoform gauze packing should be inserted in a similar manner.

COMPLICATIONS

Bleeding, hematoma, recurrence.

FOLLOW-UP

Word catheters should be left in place for 4 to 6 weeks. Iodoform gauze packing should be gradually removed over the course of several days. Recurrence is frequent, and many prefer marsupialization to simple drainage in all but the most acute cases.

CPT CODE(S)

56420 Incision and drainage of Bartholin gland abscess

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Eckert LO, Lentz GM. Infections of the lower genital tract. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:572.

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