8.05 Bartholin Abscess
======================

agk's Library of Common Simple Emergencies

Presentation
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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:
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- If the swelling is mild without fluctuance 
    (bartholinitis) or if the abscess is not 
    pointing, the patient can be placed on an 
    antibiotic (e.g., ciprofloxacin 500mg and 
    azithromycin 1000mg po once, ofloxacin or 
    doxycycline 100mg po bid x14d) and 
    instructed to take warm sitz baths. Early 
    followup should be provided.
- When the abscess is pointing, an incision 
    should be made over the medial bulging 
    surface and the pus evacuated.
- After drainage a Word catheter should be 
    inserted through the incision. Inflate the 
    tip of the catheter with sterile water to 
    hold it in place and prevent premature 
    closure of the opening.
- After drainage, the patient should be placed 
    on antibiotics and instructed to take sitz 
    baths.
- Provide for a followup exam within 48 hours.

What not to do:
---------------

- Do not mistake a nontender Bartholin duct 
    cyst, which does not require immediate 
    treatment, for an inflamed abscess.
- Do not mistake a more posterior perirectal 
    abscess for a Bartholin abscess. The 
    perirectal abscess requires a different 
    treatment approach.

Discussion
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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 ensure 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.

Illustration
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img/cse0805.gif

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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