Bartholin Abscess
Simply stated, incising, packing, and open drainage of a Bartholin gland abscess is strongly discouraged. The standard treatment is the placement of a Word catheter, a simple procedure that can be used to treat an asymptomatic cyst and a full-blown abscess - James R. Roberts MD
HWN Suggests
Avoid I&D for Bartholin Gland Abscess, and Try a Word Catheter Instead
The Bartholin gland abscess is a bacterial felon that is fodder for treatment in the ED. It often prompts an ED visit when a Bartholin gland becomes cystic and then infected. Recurrent abscesses require a bit more finesse, and may require a specialist for more definitive care. Traditional Bartholin abscess drainage with a specialized catheter rather than standard incision and packing, however, is garden-variety emergency medicine. An ED visit for a Bartholin gland abscess usually results in a good outcome, at least temporarily.
Articles of Interest
EM@3AM: Bartholin’s Abscess
If a patient presents with a painful fluctuant mass near the introitus and you suspect a Bartholin’s abscess, intervention is almost always needed A simple I&D is usually not a definitive treatment for a Bartholin’s abscess A Word catheter or Jacobi ring can prevent recurrence of a Bartholin’s abscess
Bartholin Glands: If your vagina is a clock, it’s 4:40 right now
With a cyst that’s asymptomatic, your doctor may recommend just watching it. With an abscess, believe me, you’ll want treatment right away. Anywhere between 3-20% of women have recurrent Bartholin abscesses, which, as you can imagine, can completely take over your life. Your chance of recurrence depends on the procedure you went through to get rid of the first one. The procedure with stitches (called marsupialization) has a higher recurrence rate, but recovery is quicker and easier compared to the catheter treatment. Your doctor will recommend one or the other. In women with recurrent abscesses, surgical removal of the entire duct is usually recommended once the inflammation calms down (the surgery is less gruesome than you are probably imaging).
Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs
The present study indicates that the Word catheter is an easy to handle, low cost outpatient procedure with acceptable short-term recurrence rates. Treatment costs are seven times lower than for marsupialization.
The “Weird” Catheter and Anal Aftercare
There are several methods for creating a fistula from the abscess cavity, but one of the best ways is to leave a Word catheter in place for 2-4 weeks to allow a drainage channel to form. Here’s the problem: Have you ever tried to find a Word catheter in your GYN room? They are usually right next to the fenestrated ear wicks, kryptonite dagger, and powdered unicorn horn. There are precedents for using a Foley catheter as an alternative, but telling a patient that she will have a 24-cm rubber tentacle hanging out of her groin for three weeks is a tough sell.
Word catheter for Bartholin’s abscess
The balloon is inflated with 3–4mls of sterile fluid to keep the catheter in place. Rarely, a stitch may be used to partly close the cut and hold the balloon in position. It is then left in place for up to 4 weeks; new skin to forms around the passage and the wound heals.
