CHAPTER 66

Bartholin Duct Cyst and Abscess

Frequently, gynecologists refer to obstruction of the Bartholin duct as a Bartholin gland cyst. The obstruction usually occurs at the surface (vestibule), and secretion of mucus by the gland leads to progressive dilation of the closed-off duct. As a consequence, the ballooned duct produces a swelling in the vestibule adjacent to the posterolateral margin of the hymenal ring (Fig. 66–1A). Pressure causes the swelling to be sensitive and even painful to touch (Fig. 66–1B). If the duct is colonized via vaginal or rectal flora, then the mucous cyst may become septic, producing a Bartholin duct abscess. This disorder is associated with cellulitis, erythema, and fever.

Treatment for a Bartholin cyst or abscess is drainage. A large opening should always be made in the cyst and its walls prevented from coapting and closing for 1 to 2 weeks. This may be accomplished by a variety of techniques, including marsupialization of residual margins of the open duct, insertion of a drain, and insertion of a Word catheter. The simplest technique is usually the best treatment regimen (Fig. 66–2A through C).

The patient may be anesthetized with general, regional, or local anesthesia. Two or three 0 Vicryl sutures are placed into the labia on the affected side and into the crural fold for retraction. The cystic swelling is incised vertically, and the draining interior fluid is cultured. Next, the skin and cyst wall are cut away, thereby greatly enlarging the opening (Fig. 66–3A through E

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