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8.05 Bartholin Abscess


Presentation

A woman complains of vulvar pain and swelling that has developed over the past 2-3 days, making walking and sitting very uncomfortable. On physical exam in the lithotomy position, there is a unilateral (occasionally bilateral), tender, fluctuant, erythematous swelling at 5 or 7 o'clock within the posterior labium minus.

What to do:

What not to do:

Discussion

The most common organisms involved in the development of a Bartholin abscess are gonococci, streptococci, Escherichia coli, Proteus and Chlamydia, and often more than one organism is present. Bilateral infections are more commonly characteristic of gonorrhea. The Word catheter is a 5 mL balloon on a 5 cm catheter designed to retain itself in the abscess cavity for 4-6 weeks to help insure the development of a wide marsupialized opening for continued drainage, but they seldom stay in place that long. Iodoform or plain ribbon gauze can be inserted into the incised abscess as a substitute. If a wide opening persists, recurrent infections are not likely to occur, but they are common if the stoma closes.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD