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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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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.
69
IJDV
: 12,7 (12-14)
Lekosit
: 6,5 x 103/mm3
Erythrocyte : 4, 31 x 106/mm3
ESR
GDP
CT/BT
: 830 / 300
VDRL
: Non reactive
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
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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REFERENCES
1.
2.
3.
4.
5.
71
IJDV
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
72
St.
Louis:
Mosby,