The Journal of Emergency Medicine, Vol. 36, No. 4, pp.
388 –390, 2009
doi:10.1016/j.jemermed.2008.05.019
Technical
Tips
NOVEL TECHNIQUE FOR MANAGEMENT OF BARTHOLIN GLAND CYSTS
AND ABSCESSES
Vitaly A. Kushnir, MD
Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, Newark, New Jersey
Reprint Address: Vitaly A. Kushnir, MD, Department of Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, MSB
E-506, 185 South Orange Avenue, Newark, NJ 07101-1709
e Abstract—Background: Definitive methods for treatment
of a Bartholin cyst and abscess include placement of a Word
catheter, marsupialization, application of silver nitrate, and
surgical excision. Placement of a Word catheter is the most
frequently employed technique for office and emergency de-
partment (ED) management. However, many institutions do
not have the Word catheter available; in addition, the catheter
has a tendency to dislodge before epithelialization, leading to
recurrence of the cyst. Objective: We have developed a simple
technique for management of Bartholin gland abscess or cyst
using readily available materials. This technique involves us-
ing a small loop of plastic tubing, which is secured to prevent
expulsion before epithelialization of a drainage tract. Case
Report: A 25-year-old woman presented to the ED with a
Bartholin gland abscess. After administration of local anes-
thetic, a loop of tubing was placed, allowing for drainage of the
abscess. The patient was discharged home with a course of
oral antibiotics. At 3-week follow-up, the Bartholin gland
abscess was found to be healed; the device was removed
without difficulty, leaving two drainage tracts. Conclusion:
This technique may be used as an alternative to placement of
a Word catheter for management of Bartholin gland abscess
or cyst. © 2009 Elsevier Inc.
e Keywords—Bartholin gland abscess; cyst; Word cathe-
ter; vulva
INTRODUCTION
Definitive methods for treatment of a Bartholin cyst and
abscess include placement of a Word catheter, marsupi-
RECEIVED: 23 March 2008; FINAL SUBMISSION RECEIVED:
ACCEPTED: 7 May 2008
Copyright © 2009 Elsevier Inc.
Printed in the USA. All rights reserved
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and Claudia Mosquera, MD
alization, application of silver nitrate to the abscess cav-
ity, curettage and suture, and surgical excision (1–7).
Placement of a Word catheter is the most frequently
employed technique for office and emergency depart-
ment (ED) management (2,3). The advantages of the
Word catheter include: simplicity, in-office placement,
and resumption of intercourse after placement. However,
in our clinical experience, lack of availability of the
Word catheter at many institutions, and its tendency to
dislodge, limit its clinical application. We have devel-
oped a simple technique for management of Bartholin
gland abscess or cyst using readily available materials.
This technique employs a loop of tubing to allow com-
plete epithelialization of a drainage tract while the device
is secured in place to prevent expulsion.
CASE REPORT
A 25-year-old woman, G6P3033, presented to the ED
complaining of a painful vulvar mass of 2 days duration.
She denied any medical or surgical history, previous
sexually transmitted diseases, and gynecological prob-
lems. The patient was found to be afebrile; the pelvic
examination revealed a tender 6-cm right vestibular mass
with associated vulvar erythema and edema. Bartholin
gland abscess was diagnosed and definitive methods of
treatment were reviewed with the patient (1–7). The
patient elected to undergo placement of a Word catheter;
4 May 2008;
388
Bartholin Gland Cysts and Abscesses
however, our institution (like many others) does not have
these catheters available. We proposed placing a device
similar to the Word catheter that would permit complete
epithelialization of a drainage tract. In the ED, the ab-
scess cavity was drained and a loop of tubing was placed
using the technique described below. The patient re-
ceived broad-spectrum antibiotics and was instructed to
undergo pelvic rest and to take sitz baths at home.
When the patient returned for a 3-week follow-up, the
Bartholin gland abscess was found to be healed and the
device was removed without difficulty, leaving two
drainage tracts.
Procedure Description
Our technique is performed using sterile preparation and
administration of a local anesthetic. The wall of the cyst
or abscess is grasped with a small forceps, and a No. 11
blade is used to make a 2-mm stab incision into the cyst
or abscess. It is important to grasp the cyst wall before
the incision is made; otherwise, the cyst may collapse,
and a false tract be created. The incision should be within
the introitus external to the hymenal ring in the area of
the duct orifice. After the initial incision is made, a
hemostat is used to break up loculations. The hemostat is
then advanced 2 cm superior to the initial incision and a
second 2-mm stab incision is made using a No. 11 blade.
At this point, a 5-cm piece of tubing from a butterfly
vacutainer with a piece of vicryl suture threaded through
the lumen is grasped and pulled through the second stab
incision and out the first, using the hemostat. The vicryl
suture is then tied to secure the device in place, creating
a loop (Figure 1), and the ends of the suture are trimmed.
This allows a portion of the device to remain in the
abscess cavity while the device is secured to prevent
Figure 1. Loop of plastic tubing used to drain the Bartholin
gland abscess.
389
expulsion. The device is left in place until epithelializa-
tion occurs 3 to 5 weeks later. At that point, the suture is
cut and the device is removed.
The equipment used for this procedure includes the
following: sterile gloves, iodine solution, lidocaine 1%
solution, 30-gauge (1-inch) needle with 5-mL syringe for
injecting lidocaine, small forceps for grasping cyst wall,
No. 11 scalpel, hemostat to break up loculations, scis-
sors, and 5-cm piece of butterfly vacutainer tubing with
vicryl suture threaded through the lumen.
DISCUSSION
Because simple incision and drainage of a Bartholin
gland abscess carries a high risk of recurrence, tech-
niques that pack the cavity or leave a catheter that allows
for formation of a drainage track are widely employed
(8). The technique of using a loop of tubing has several
advantages over placement of a Word catheter, including
comparable ease of placement, availability of the equip-
ment in most institutions and offices, and, in addition, the
loop device is less likely to dislodge. The disadvantages
include need for pelvic rest and relative discomfort of a
foreign body. Furthermore, the loop device creates two
drainage tracts, in comparison to one tract created with
the Word catheter. The majority of Bartholin gland ab-
scesses involve the anaerobic and aerobic bacteria nor-
mally found in the vagina; however, sexually transmitted
infections with Neisseria gonorrhoeae and Chlamydia
trachomatis are common. Antibiotics are indicated if
there are significant surrounding cellulites; appropriate
coverage for Chlamydia and gonorrhea may be admin-
istered pending results of cultures (8 –10). This technique
should not be used in patients who are at risk for Bar-
tholin gland cancer (11,12). A randomized controlled
trial is needed to evaluate the clinical utility of this
technique in comparison to the Word catheter.
CONCLUSION
This technique may be used as an alternative to place-
ment of a Word catheter for management of Bartholin
gland abscess or cyst.
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