8.05 Bartholin Abscess

agk’s Library of Common Simple Emergencies

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:

• 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

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.

Illustration

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