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C H A P T E R 67
Bartholin Duct Cyst and Abscess
PART 3 n SECT ION 12

Michael S. Baggish
Frequently, gynecologists refer to obstruction of the Bartholin drain, and insertion of a Word catheter. The simplest technique
duct as a Bartholin gland cyst. The obstruction usually occurs at is usually the best treatment regimen (Fig. 67-2A to C).
the surface (vestibule), and secretion of mucus by the gland The patient may be anesthetized with general, regional, or
leads to progressive dilation of the closed-off duct. As a conse- local anesthesia. Two or three 0 Vicryl sutures are placed into
quence, the ballooned duct produces swelling in the vestibule the labia on the affected side and into the crural fold for retrac-
adjacent to the posterolateral margin of the hymenal ring (Fig. tion. The cystic swelling is incised vertically, and the draining
67-1A). Pressure causes the swelling to be sensitive and even interior fluid is cultured. Next, the skin and cyst wall are cut
painful to touch (Fig. 67-1B). If the duct is colonized via vaginal away, thereby greatly enlarging the opening (Fig. 67-3A to E).
or rectal flora, then the mucous cyst may become septic, produc- The cut edges are closed by a running lock stitch of 3-0 polydiox-
ing a Bartholin duct abscess. This disorder is associated with anone (PDS) or Vicryl. A small drain is sutured into the cavity
cellulitis, erythema, and fever. with 3-0 chromic or plain catgut (Fig. 67-4). The patient is
Treatment for a Bartholin cyst or abscess is drainage. A large instructed to soak for 10 to 15 minutes in a tub bath to which
opening should always be made in the cyst and its walls pre- 2 cups of salt (e.g., Instant Ocean sea salt) has been added twice
vented from coapting and closing for 1 to 2 weeks. This may be per day for 1 to 2 weeks. She should rinse with fresh water after
accomplished by a variety of techniques, including marsupial- the soaking. The genital area may be blown dry with a hair dryer
ization of residual margins of the open duct, insertion of a on the nonheat cycle or gently towel dried.
875
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876 PART 3 n SECTION 12 n Vulvar and Perineal Surgery
A B
FIGURE 67-1 A The obstructed duct of the Bartholin gland produces swelling in the vestibule. This will produce discomfort for the patient. In this case, no
evidence of infection is noted. B. This cystic lesion is secondary to an obstructed Skene duct.
A B
FIGURE 67-2 A. This woman was hospitalized with a painful vulvar mass,
which failed to respond to administration of oral antibiotics. She had a past
history of recurrent Bartholin duct cysts. This photo shows tremendous
swelling of the left vulva and cellulitis extending into the mons. B. Drainage
was accomplished by an incision into the mass at its most dependent, medial
(vestibular) site. The operator’s finger is inserted into the abscess cavity to
break up all septa to ensure complete drainage. Note: The finger is extended
into the lower portion of the mons. C. A circular piece of skin has been
excised (2-cm diameter), and the perimeter of the opening has been sutured
C via a running 0 Vicryl stitch. A through-and-through ½-inch Penrose drain has
been placed.
CHAPTER 67 Bartholin Duct Cyst and Abscess 877
PART 3 n SECT ION 12

A B
C
D
FIGURE 67-3 A. Another patient with a large Bartholin duct abscess, which distorts the vulva.
B. The knife blade is prepared to cut the skin and penetrate the abscess cavity medially and
dependently. C. Pus pours from the drainage site. D. A scissors is placed into the crater and spread
E open to break up any septa. E. The perimeter of the large opening (into the abscess cavity) is closed
with a running 0 Vicryl suture.
878 PART 3 n SECTION 12 n Vulvar and Perineal Surgery
A B
FIGURE 67-4 A and B. The labia on the affected side are sutured back with 0 Vicryl to provide exposure. A vertical incision is made into the cyst. The edges of
the incision are grasped with forceps and Allis clamps. The skin, together with a portion of the cyst lining, is widely cut away with a scalpel or Stevens scissors. The
edges of the cut are sutured circumferentially with 3-0 Vicryl or polydioxanone. A drain is placed into the wound and secured with 3-0 chromic catgut. The cyst
thus has been “marsupialized.”

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C H A P T E R 67

Bartholin Duct Cyst and Abscess

PART 3 n SECT ION 12

PART 3 n SECT ION 12

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