Bartholin gland abscess - Revision history

Patricklin at 08:05, 30 November 2023

2023-11-30T08:05:04Z

← Revisión anterior		Revisión del 08:05 30 nov 2023
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	==Background==		==Background==
	*~~Ducts of~~ the ~~glands drain into posterior vestibule~~ at 4 o'clock and 8 o'clock positions		*Bartholin glands are located at the at the 4 o'clock and 8 o'clock positions, posterolaterally to introitus
	*A cyst does not need to be present for an [[abscess]] to develop		**Ducts of the glands drain into posterior vestibule and contribute to vaginal lubrication
			**Glands are generally nonpalpable when cyst/abscess is not present<ref>Lee WA, Wittler M. Bartholin Gland Cyst. [Updated 2023 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.</ref>
			*Obstruction of ducts may lead to focal cyst formation, which may become infected to form an abscess
			**A cyst does not need to be present for an [[abscess]] to develop
	*Most common in young, adult women (20-30 years old)		*Most common in young, adult women (20-30 years old)

	==Clinical Features==		==Clinical Features==
	[[File:Barthonlincyst2011.png\|thumb\|Bartholin gland cyst (non-infected) of right labia at 7-8 o'clock position)]]		[[File:Barthonlincyst2011.png\|thumb\|Bartholin gland cyst (non-infected) of right labia at 7-8 o'clock position)]]
			*Pain and pressure worse with walking, sexual intercourse
			**If small cyst or abscess, may also be asymptomatic
	*Mass in posterior introitus near 4 o'clock or 8 o'clock position		*Mass in posterior introitus near 4 o'clock or 8 o'clock position
			**May appear erythematous, tender, and swollen
	**May develop over days or longer time (if preceded by cyst)		**May develop over days or longer time (if preceded by cyst)
	*Systemic symptoms (e.g. [[fever]]/chills) are rarely present		*Systemic symptoms (e.g. [[fever]]/chills) are rarely present
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	==Evaluation==		==Evaluation==
	*Usually clinical diagnosis		*Usually a clinical diagnosis
			*If there is suspicion of MRSA, may culture the specimen drained

	==Management==		==Management==
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	[[File:Wordcatheter.jpg\|thumb\|Uninflated word catheter]]		[[File:Wordcatheter.jpg\|thumb\|Uninflated word catheter]]
	[[File:Inflatedwordcatheter.jpg\|thumb\|Word catheter inflated with approximately 2 ml of saline (blunt needle preferred for injection)]]		[[File:Inflatedwordcatheter.jpg\|thumb\|Word catheter inflated with approximately 2 ml of saline (blunt needle preferred for injection)]]
			*Consider parenteral analgesics or sedatives prior to local infiltration
	#Inject [[local anesthetics]]		#Inject [[local anesthetics]]
	#~~Stab~~ incision is made on the mucosal surface		#Using an #11 blade, stab incision is made on the mucosal surface (avoid incising the skin surface on labia minora)
	#Extend incision for several mm but not so many that the Word catheter will fall out (fully inflated it is not much larger than 1cm)		#Extend incision for several mm but not so many that the Word catheter will fall out (fully inflated it is not much larger than 1cm)
	#Insert Word catheter and inflate balloon with 2-4mL of water. The safest way to do this is with a blunt needle tip (just long enough if pressure applied); the kit comes with a long 22-27 gauge needle but if using this be careful		#Insert Word catheter and inflate balloon with 2-4mL of water. The safest way to do this is with a blunt needle tip (just long enough if pressure applied); the kit comes with a long 22-27 gauge needle but if using this be careful
Línea 62:		Línea 70:

	===Wound Care===		===Wound Care===
	*Sitz bath x2 days		*Sitz bath x2 days, analgesics
	*Abstain from vaginal intercourse		*Abstain from vaginal intercourse
	*Refer to GYN if >40yr (might need biopsy to rule out CA) and recurrence (complete excision vs. marsupialization)

	==Disposition==		==Disposition==
	*Usually outpatient management		*Usually outpatient management
			*Refer to GYN if >40yr (might need biopsy to rule out CA) and recurrence (complete excision vs. marsupialization)

	==See Also==		==See Also==
Línea 81:		Línea 89:
	==References==		==References==
	<references/>		<references/>


	[[Category:ID]]		[[Category:ID]]
	[[Category:OBGYN]]		[[Category:OBGYN]]
	[[Category:Procedures]]		[[Category:Procedures]]

Rossdonaldson1: /* Differential Diagnosis */

2023-05-03T16:48:44Z

Differential Diagnosis

← Revisión anterior		Revisión del 16:48 3 may 2023
Línea 15:		Línea 15:
	*Lipoma		*Lipoma
	*Carcinoma (consider in older women who present with introital mass)		*Carcinoma (consider in older women who present with introital mass)
			{{Pelvic pain DDX}}
	{{SSTI DDX}}		{{SSTI DDX}}

Rossdonaldson1: /* Rubber Ring Catheter (Jacobi Ring)Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90 */

2023-05-03T15:22:32Z

Rubber Ring Catheter (Jacobi Ring)Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90

← Revisión anterior		Revisión del 15:22 3 may 2023
Línea 36:		Línea 36:

	====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====		====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====
	[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]		[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. American Journal of Emergency Medicine. May 2005. 23(3);414-415 DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]
	[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]		[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. American Journal of Emergency Medicine. May 2005. 23(3);414-415 DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]
	''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''		''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''
	#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.		#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.
Línea 45:		Línea 45:
	#Grab one end of Jacobi ring and pull through [[abscess]] cavity		#Grab one end of Jacobi ring and pull through [[abscess]] cavity
	#Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)		#Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)


	~~Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033~~

	===Antibiotics===		===Antibiotics===

Rossdonaldson1: /* Rubber Ring Catheter (Jacobi Ring)Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90 */

2023-05-03T15:20:15Z

← Revisión anterior		Revisión del 15:20 3 may 2023
Línea 36:		Línea 36:

	====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====		====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====
	[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext ~~AEJM article~~]</ref>]]		[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]
	[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext ~~AEJM artle~~]</ref>]]		[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033]</ref>]]
	''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''		''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''
	#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.		#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.
Línea 45:		Línea 45:
	#Grab one end of Jacobi ring and pull through [[abscess]] cavity		#Grab one end of Jacobi ring and pull through [[abscess]] cavity
	#Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)		#Tie two ends to form closed ring. DO NOT TIE TOO TIGHT (pressure necrosis risk)


			Gennis P, et al. Jacobi ring catheter treatment of Bartholin's abscesses. DOI:https://doi.org/10.1016/j.ajem.2005.02.033

	===Antibiotics===		===Antibiotics===

Rossdonaldson1 at 15:18, 3 May 2023

2023-05-03T15:18:03Z

← Revisión anterior		Revisión del 15:18 3 may 2023
Línea 36:		Línea 36:

	====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====		====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====
	[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM ~~artle~~]</ref>]]		[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM article]</ref>]]
	[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]		[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]
	''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''		''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''

Rossdonaldson1: /* Management */

2023-05-03T15:16:54Z

Management

← Revisión anterior		Revisión del 15:16 3 may 2023
Línea 36:		Línea 36:

	====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====		====Rubber Ring Catheter (Jacobi Ring)<ref>Gennis P, Li SF, Provataris J, Shahabuddin S, Schachtel A, Lee E, Bobby P. Jacobi ring catheter treatment of Bartholin’s abscesses. Am J Emerg Med. 2005 May;23(3):414-5</ref><ref>Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May;36(4):388-90</ref>====
	[[File:Jacobi.jpg\|thumb\|<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]		[[File:Jacobi.jpg\|thumb\|Jacobi ring catheter<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]
	[[File:To_do.jpg\|thumb\|<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]		[[File:To_do.jpg\|thumb\|Jacobi ring catheter placement technique.<ref>[http://www.ajemjournal.com/article/S0735-6757(05)00083-5/fulltext AEJM artle]</ref>]]
	''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''		''Less cumbersome for the patient and less likely to fall out and similar in procedure as a loop drain for a cutaneous abscess''
	#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.		#Additional equipment: 7-cm length of an 8–French T tube (can also use tubing from butterfly catheter) threaded with a 20-cm length of 2-0 silk suture.

Rossdonaldson1: /* Antibiotics */

2023-05-03T15:14:20Z

Antibiotics

← Revisión anterior		Revisión del 15:14 3 may 2023
Línea 47:		Línea 47:

	===Antibiotics===		===Antibiotics===
	No randomized trials, general approach from expert opinion		''No randomized trials, general approach from expert opinion''

	'''Limit antibiotic treatment to patients with:'''		'''Limit antibiotic treatment to patients with:'''

Zbuchwald: /* Antibiotics */

2023-04-29T22:51:39Z

Antibiotics

← Revisión anterior		Revisión del 22:51 29 abr 2023
Línea 47:		Línea 47:

	===Antibiotics===		===Antibiotics===
			No randomized trials, general approach from expert opinion

			'''Limit antibiotic treatment to patients with:'''

			*Recurrent Bartholin Abscess
			*High risk of complications
			*Surrounding Cellulitis, immunocompromise, pregnancy
			*Systemic Infection (eg, fever, chills)

			'''Regimens:'''

			*[[Bactrim]] 1 DS PO BID + [[Amoxicillin-clavulanate]]: 875mg PO BID
	*[[Cefixime]] 400mg PO QD x7d + [[clindamycin]] 300mg PO QID x7d		*[[Cefixime]] 400mg PO QD x7d + [[clindamycin]] 300mg PO QID x7d

Blsimpso: /* External Links */

2021-10-07T00:51:51Z

External Links

← Revisión anterior		Revisión del 00:51 7 oct 2021
Línea 61:		Línea 61:

	==External Links==		==External Links==
			*[https://www.merckmanuals.com/professional/gynecology-and-obstetrics/miscellaneous-gynecologic-disorders/bartholin-gland-cysts Merck Manual - Bartholin Gland Cyst]
			*[https://first10em.com/word-catheters/ First10EM - What's the word on Word Catheters?]

	===Videos===		===Videos===
	{{#widget:YouTube\|id=MmxiG-0IvDE}}		{{#widget:YouTube\|id=MmxiG-0IvDE}}


	==References==		==References==

Blsimpso: /* Background */

2021-10-07T00:42:32Z

Background

← Revisión anterior		Revisión del 00:42 7 oct 2021
Línea 2:		Línea 2:
	*Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions		*Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions
	*A cyst does not need to be present for an [[abscess]] to develop		*A cyst does not need to be present for an [[abscess]] to develop
			*Most common in young, adult women (20-30 years old)

	==Clinical Features==		==Clinical Features==