CASE REPORT

BARTHOLINS ABCESS CAUSED BY ESCHERICHIA COLLI

Endang tri wahyuni, Muhammad Dali Amiruddin, Alwi Mappiasse
Departement of Dermatovenereology Medical Faculty of Hasanuddin University / Wahidin
Sudirohusodo Hospital Makassar

ABSTRACT
Bartholin's abscess involves an accumulation of pus that forms a lump
(swelling) in one of the mucous-producing Bartholin's glands. A
Bartholin's abscess forms when a duct from the gland gets blocked. This
swelling is hot to the touch, sensitive, and painful. Many different types
of bacteria can cause the infection.
Reported a case of Bartholins abcess in a woman 47 years old. Poor
personal hygiene are predispotition factor in this patient. Bacteria culture
showed Escherichia coli as the etiology. Treatment using oral antibiotic,
vertical incision and drainage gave satisfactory result.
Keyword : bartholins abcess, Escherichia coli, incision and drainage

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Endang Tri Wahyuni

Bartholin Abcess Caused By Escherichia Colli

and only 10% in the incidence of recurrent

abscesses.10
This is a case reportof bartholins
abcess in a woman, 47 years old, caused
by E.coli, and the treatment is incision and
drainage.

INTRODUCTION
Bartolins glands was first introduced
by a Dutch anatomist in the year
1677.1This gland is the largest vestibular
glands which resembles Cowper glands
(bulbourethral glands) in males.1,2,3
Bartholini gland is the vulvovaginal
bilateral, located in the labium minor about
at the four and eight o'clock positions
posterolateral aspect of vestibulum.2,4,5
Approximately normal sizeof a pea. Each
gland mucus release into the duct length is
approximately 2.5 cm and the orifice
located on the lateral hymenal ductus in
the indentation between the hymen and
the labium minor.Its function is to maintain
surface
moisture
vagina
vestibular
mucosa.1,3 In the normal gland was not
palpable unless there is illness or
infection.2
Abscesses are accumulation of pus
which causes swelling in one of the
bartholins glands that produce mucous.5
Abscess of Bartolins glands have formed
when the channel closure, cause intense
swelling that occurs is pain, tenderness
and warm in palpable.7 Increasing the
secretion of the glands and can cause
infection. Bartholins gland abscess is
almost three times more common than
cystic duct Bartolini. Bartholins gland
abscesses are common in women in the
reproductive periode. Gland infection is
not always caused by an infection
transmitted through sexual.6
Bartolins abscesses can be caused
by organisms pyococcal,
gonococcus
andChlamydia trachomatis. In one study
only about 21 of 109 cases caused by
staphylococci, while 50 cases are caused
by Escherichia coli and 46 cases caused
by Streptococcus faecalis.8
Treatment is recommended Bartholins abscess incision drainage.6,9
Antizbiotics can be given to fight infection,
but not all cases require antibiotics if the
abscess can be issued .6
The prognosis of this disease is
good,it is seen from the response to
treatment with a satisfactory improvement

CASE REPORT
A woman 47 years old, have
married, came to dermatovenereology
clinic Wahidin Sudirohusodo hospital
(RSWS) Makassar, complaint with nodule
in the labium majora since 4 days ago.
Nodule gradually more bigger than before,
it more pain after activities. The patient
have take oral antibiotic (amoxycillin) by
herself and analgetic, but the complain not
reduce. History of sexual contact one
week earlier denied and there was not a
history of fluor albus.
General condition and nutritional
status were good. Vital sign were normal.
Physical examination at right labia minora
were erythematous nodule with pain and
fluctuation. There was no vaginal secret.
(Picture 1) According to anamnese and
phisical examination the diagnose was
bartholinitis.

Picture 1.Bartholins glandabscess showed

erythematous nodule with fluctuation.

Laboratory examination in normal values

(table 1), after incision and drainage, the
pus was aspirated and examined.
The laboratory examination were gram
staining, culture, VDRL. The treatment are
doxicyclin 100 mg twice a day and natrium
diclofenak 2 x 50 mg.

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Vol.1 No.1 2012

Picture of operative procedure

Tabel 1. Laboratorium examinattion results

Routine Blood :
Hb

: 12,7 (12-14)

Lekosit

: 6,5 x 103/mm3

Erythrocyte : 4, 31 x 106/mm3
ESR

: 35/66 (kurang 20)

GDP

: 111 (kurang 140)

CT/BT

: 830 / 300

VDRL

: Non reactive

Picture 2 and 3. Vertical incision and drainage the

bartholins abscess

Picture post incision and drainage

Urine sedimentation :
Leucocyte

: 7 (0-5/LPB)

Erythrocyte

: 3 (0-3/LPB)

Epithel

: + +++ penuh

Ca oxalat

: +
Picture 4. Scar post incision, seen no more
erythematous nodule and painless

Gram staining :
positive
There are negative gram bacillus
Culture
Aerob
: Escherichia coli
Anaerob : There is no growth

DISCUSSION
Bartholins glands (greater vestibular glands) are homologues of the
Cowpers glands (bulbourethral glands) in
males. At puberty, these glands begin to
function, providing moisture for the
vestibule.1 Bartholini cyst is a obstruction
of one of bartholin duct caused by genital
infection, inflamation or mucous. The
symptoms are painless nodule in vulva. In
infection it become very pain bartholins
abcess.2 Bartholins abcess is accumulation of secret cause sweeling in one of
the gland which produce mucous.5
Bartholins abcess appear when the duct
is closed, swelling can causes very pain,
sensitive, and hot in palpable.7 This is
according to case with complains are
nodule erytematous in genital area very
pain, mainly if patient had activity.
Bartholins abcess often found in
reproductive women at 2% aged 20-40
years old.11But a case bartholins abcess
in one month baby had been reported. 12

Result of sensitivity test

Drugs

Kons Disk

1. Astreonam
30 g
2. Cefazolin
20 g
3. Amoxycillin
8 g
4. Ceftazidin
26 g
5. Cefuroxim
20 g
6. Ceptriazon
30 g
7. Doxyciclin
18 ug
8. Streptomycin
10g
9. Chloramphenicol 8 g
10. Tetracycline
24 g
11. Sulfamethoxasole 18 g
12. Sulfaperason
25 g
13. Neomicin
18 g
14. Norfloxacin
12 g

Ket
S
S
R
S
S
S
S
S
R
S
S
S
S
R

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Endang Tri Wahyuni

Bartholin Abcess Caused By Escherichia Colli

still open, noedemaandpuswas found,

treatmentwas continued.
Bartholins gland cyst treatment
depends on the symptoms caused. For the
case of Bartholins gland cysts are
asymptomatic may not require treatment,
but Bartholins gland cysts and abscesses
are symptomatic should be taken incision
drainage. Barring a spontaneous rupture,
abscess Bartholin rarely heal themselves.16 Although incision and drainage is
a procedure that is relatively quick and
easy, and proven to quickly cure the
patient but this technique has a tendency
to cause recurrent cysts or abscesses.17
Prognosis is quite good with
Bartholins abscess recurrence rate of less
than 20%. In case of recurrence up to
several times it can be done bartholins
cyst excision in the absence of active
infection. Scarring, and complications of
chronic pain after surgery can occur when
previously been carried out several
measures for the drainage of secretions /
abscess so the possibility of adhesions
that would complicate the act of excision.6
Education given to these patients was to
maintain the good hygiene of body and
sex.

This is according to case with patient

is a woman 40 years old who has married.
Bartholins abcess more big until 8
cm in diameter after four or five days.13
The incidens of infection bartholin gland
associated by sexual transmitted disease.
Although Neisseria gonorrhoeae is a
predominant caused, but the other
anaerob isolate also can caused
bartholins abcess. It reported by Brook
that there were 67 different pathogens
isolated from vagina in case bartholins
abcess. 14 Patient in this case with achieve
compain of sweeling in vulva area with
small nodule and gradually more biger
after four days.Gram staining examination
is negative and cultur examination there
were aerob isolate Escherichia coli.
Escherichia coli is a family of
Enterobacteriaceae. Enterobacteriaceaeis
a main normal flora in human intestinal,
but it become pathogen if found in other
body.
Enterobacteriaceaecan
cause
infection in extra intestinal, specially in
tractus urinarius.15The patient in this case ,
there was infection of E.coliin bartholin
gland maybe caused by poor hygiene and
cause migration pathogen.
The treatment in this case were
doxicyclin 2 x 100 mg and natrium
diclofenac 2 x 50 mg before there is result
of sensitivity test. And after the sensitivity
test the treatment is still gave doxicyclin
100 mgtwice a day on 7 days. Doxicyclin
is a second generation of tetracyclin with
inhibits protein synthese with binding
ribosom 30S subunit and 50S, and can
use for gram negative and positive.
In addition to antibiotics, the management of the patient's incision and
drainage, this was done because the size
of the tumor mass is large enough, aim for
the drainage of secretions as much as
possible. After incision of action, complaint
of patient reduced , and outpatient care to
evaluate and monitor the patient's
condition. On the third day, drain off the
set when urinating, afteran evaluation
ofthe drainwas not there, the incisionwas

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