OFFICE TREATMENT OF BARTHOLIN’S GLAND ABSCESS OR CYST

ALBERT MATHIEU, M.D.

Associate Professor of Obstetrics and Gynecology, University of Oregon Medical School; Attending Gynecologist, MuItnomah Hospital ,

PORTLAND, OREGON

B ARTHOLIN’S gIand abscess or cyst BARTHOLIN’S GLAND ABSCESS

can be treated satisfactorily in one’s The red, painful and ffuctuating sweIIing office with a minimum of expense and in the region of the Bartholin’s gIands is

FIG. I. The gland is held firmly between the thumb and the index finger. An incision, about

FIG. 2. The heated blade of a Post cautery is

I cm. long, is made through the skin in the thrust through the opening in the gland, and

dependent portion of the mass in the region the lining of the gland is destroyed by vertical

of the duct. In case of abscess of Bartholin’s and horizonta1 movements with the bIade tip.

gland, the incision is made in the same pIace, but it is made a little bit longer and extends diagnostic of Bartholin’s gIand abscess. into the gIand itseIf. When the pus is evacu- There is onIy one treatment for this condi- ated, a small gauze strip is inserted to keep the incision from cIosing prematureIy.

tion, incision and drainage.

discomfort to the patient. I have used the Under local ethy1 chloride anesthesia the

procedures described here for six years and incision is made at the dependent portion

have found them to be simpIe, safe and of the gIand, near the mucocutaneous

curative. border. The abscess shouId not be squeezed or massaged after the incision has been

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220 American Journal of Surgery Mathieu-BarthoIin GIand

made. A smaI1 gauze strip is then inserted into the opening, and it is repIaced with a cIean one every other day for three or

FIG. 3. The wound one week after the cauterization. Drainage continues through this opening and the healing takes pIace from the base of the wound. In one month or Iess the wound is heaIed.

four times. This insures adequate drainage and prevents the incision from cIosing too earIy.

The physician must know that this is mereIy an emergency treatment and that when the wound has heaIed, if the duct of the gIand does not reopen, the continued function of the gIand may Iead to the formation of a cyst. He shouId inform the patient of this, and instruct her to return for remova of the cyst if one shouId form and cause her inconvenience. He shouId aIso teI1 the patient that there are two Bartho- Iin’s gIands.

BARTHOLIN’S GLAND CYST

In many cases of BarthoIin’s gIand abscess the gIand and its duct are de-

stroyed, and foIIowing incision and drain- age there is a permanent cure. However, in many cases the mucous membrane Iining of the gIand does not Iose its abiIity to secrete mucus, and if the duct remains cIosed there wiI1 ensue a BarthoIin’s gIand cyst which wiI1 sIowIy enIarge to the point of producing great inconvenience.

BarthoIin’s gIand cyst is treated in the foIIowing manner: Under intravenous evi- pa1 or pentotha1 sodium, or under nitrous oxide or ethyIene anesthesia, after aseptic and antiseptic precautions, the cyst is grasped between two fingers and an inci- sion, approximateIy I cm. in Iength, is made through the skin, as near the duct opening as possibIe (Fig. I). Through this incision the hot bIade of a Post cautery is inserted into the cyst, and, then, by a series of vertical and IateraI strokes, the entire waI1 of the cyst is destroyed by actua1 cautery (Fig. 2). If the incision is made cIose enough to the opening of the duct, the duct wiI1 aIso be destroyed. No packing is necessary .‘as the cauterized edges of the incision wiI1 remain open unti1 the entire site of the cauterization has heaIed. There is no bIeeding and onIy sIight discomfort foIIowing this procedure. The entire operation can be done in about three minutes, and within two or three hours the patient is abIe to get up and waIk home.

The wound heaIs sIowIy by granuIation from its base, and in one week has the appearance shown in Figure 3. During this time there is practicaIIy no discomfort to the patient. At the end of one month the wound is cIosed and heaIed with a hardly perceptibIe scar.

SUMMARY

An o&e method of treating Bartholin’s gIand abscess and BarthoIin’s gIand cyst is shown. The cyst Iining is destroyed by means of the Post cautery through a smaI1 incision, and iIIustrations are given to demonstrate the method.