Bartholin's cyst Flashcards
A 23-year-old woman attends the emergency gynaecology clinic having been referred by her general practitioner with vulval pain. On examination, there is a 1.5cm fluctuant swelling at the medial aspect of her right labia minora near the vaginal introitus which is exquisitely tender. She has palpable superficial inguinal lymphadenopathy. There is no evidence of vaginal discharge, and the woman denies unprotected intercourse.
What is the most appropriate procedural management?
A. Hymenectomy
B. Deinfibulation
C. Insertion of a balloon catheter
D. Cerclage
E. Insertion of a vaginal ring pessary
C. Insertion of a balloon catheter
Insertion of a balloon catheter (often referred to as a Word catheter) is one of the preferred management strategies for symptomatic Bartholin’s cyst abscess. Under local anaesthesia, a stab incision is made into the labia minora, over the abscess, and the contents of the abscess drained. A balloon catheter is then inserted into the cyst cavity and the balloon inflated with 2-4mL of saline. A suture may be placed to keep the catheter in place. The catheter remains in place for up to 4 weeks to allow epithelialisation of the tract to occur.
B: Not Deinfibulation
einfibulation refers to a surgical procedure to restore the vaginal introitus in women who have undergone type III female genital mutilation (infibulation, or surgical closure/narrowing of the vaginal introitus).
E. Vaginal ring pessary
Vaginal ring pessaries are used for the conservative management of pelvic organ prolapse such as a cystocele or rectocele.
what are the bartholin’s gland:
The Bartholin’s glands are a pair glands located either side of the posterior part of the vaginal introitus (the vaginal opening). They are usually pea-sized and not palpable. They produce mucus to help with vaginal lubrication.
When the ducts become blocked, the Bartholin’s glands can swell and become tender, causing a Bartholin’s cyst. The swelling is typically unilateral and forms a fluid-filled cyst between 1 – 4 cm.
Cysts can become infected, forming a Bartholin’s abscess. A Bartholin’s abscess will be hot, tender, red and potentially draining pus.
A diagnosis of a Bartholin’s cyst or abscess is made clinically with a history and examination.
management of Bartholin’s cysts
Bartholin’s cysts will usually resolve with simple treatment such as good hygiene, analgesia and warm compresses. Incision is generally avoided, as the cyst will often reoccur.
A biopsy may be required if vulval malignancy needs to be excluded (particularly in women over 40 years).
Bartholin’s abscess treatment:
A Bartholin’s abscess will require antibiotics.
A swab of pus or fluid from the abscess can be taken to culture the infective organism and check the antibiotic sensitivities.
E. coli is the most common cause. Send specific swabs for chlamydia and gonorrhoea.
Surgical management of Bartholin’s cysts options:
- Word catheter (Bartholin’s gland balloon) – requires local anaesthetic
- Marsupialisation – requires general anaesthetic
what is a word catheter?
A Word catheter is a small rubber tube with a balloon on the end. The procedure may be performed by an appropriately experienced person in a treatment room, rather than a theatre. Local anaesthetic is used to numb the area. An incision is made, and any pus is drained from the abscess. The Word catheter is inserted into the abscess space, and inflated up to 3 ml with saline. The balloon fills the space and keeps the catheter in place. Fluid can drain around the catheter, preventing a cyst or abscess reoccurring. The tissue heals around the catheter, leaving a permanent hole. The catheter can be deflated and carefully removed at a later date, once epithelisation of the hole has occurred
what is marsupialisation:
Marsupialisation involves a general anaesthetic in a surgical theatre. An incision is made, and the abscess is drained. The sides of the abscess are sutured open. Suturing the abscess open allows continuous drainage of the area and prevents recurrence of the cyst or abscess.
Bartholin’s cyst management
