Bartholin’s Cyst and Abscess: Word Catheter Insertion, Marsupialization

CHAPTER 131 Bartholin’s Cyst and Abscess


Word Catheter Insertion, Marsupialization



Bartholin’s glands are located at the vaginal opening between the hymenal ring and labia minora (at approximately the 5 and 7 o’clock positions). Simple incision and drainage (I&D) of a Bartholin’s duct cyst or gland abscess may give immediate results with significant pain relief, but recurrence after such a procedure is common. Bartholin’s cysts and abscesses are best treated using a Word catheter to induce the formation of an epithelialized tract from the vulvar vestibule to the cyst. This allows continued functioning of the Bartholin’s gland, proper drainage, and minimal recurrence. The recurrence rate using this technique is between 2% and 15%. The Word catheter has a short latex stem with an inflatable bulb at the distal end (Fig. 131-1) and can be used for both conditions.



For patients with noninflamed and recurrent Bartholin’s cysts, marsupialization is a permanent cure. The procedure can be performed in the office but often is done as a same-day surgical procedure. It is very well tolerated by patients, with a rapid healing time and minimal postprocedure discomfort. Complications are rare and the technique is easily learned, especially by those physicians familiar with perineal repairs.







Procedure



Word Catheter Placement




2 Prepare the labia and vagina with the antiseptic solution. It is preferable to enter the cyst (Fig. 131-2A) or abscess from the vaginal side of the introitus unless this would require a much deeper incision (Fig. 131-2B). Inject lidocaine over the intended site of entry. If the incision is to be made external to the introitus where the abscess is “pointing,” plan to insert the catheter approximately in the area of the original duct orifice, immediately adjacent the hymenal ring (Fig. 131-2C).

3 Lance or incise the cyst or abscess with a no. 11 scalpel blade (see Fig. 131-2C). It is essential that the stab wound penetrate the cyst or abscess wall, which will be evidenced by the free flow of pus or mucus. Culture contents if indicated. Although the majority of simple cysts are sterile, abscesses are typically polymicrobial, and many others contain Neisseria gonorrhoeae. Culture usually will not change initial management. The stab wound must be just large enough for the catheter to be inserted, usually 3 to 4 mm.

May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Bartholin’s Cyst and Abscess: Word Catheter Insertion, Marsupialization
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