How is incision and drainage of Bartholin abscess performed?

Updated: Nov 17, 2017
  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Explain the procedure, risks, benefits, possible complications, alternative options, and postprocedure care to the patient or her legal representative and obtain a written informed consent. A female chaperone should be present in the procedure room throughout the procedure.

Place the patient in the lithotomy position and spread open the labia (see image below). An assistant may aid with traction of the labia during the procedure.

Bartholin abscess. Bartholin abscess.

Use the sterile skin preparatory solution to clean the labia and surrounding area (see image below).

Skin preparation. Skin preparation.

Infiltrate 2-3 mL of lidocaine 1% subcutaneously under the mucosa of the labia minora (see image and video below).

Mucosal infiltration with lidocaine. Mucosal infiltration with lidocaine.
Mucosal infiltration with lidocaine.

Large abscesses or cysts that seem to be under high pressure may be partially needle-decompressed prior to incision with the blade in order to prevent high-pressure drainage upon incision (see image and video below). Complete needle decompression could make it harder to ensure proper identification of the abscess cavity and should be avoided.

Needle aspiration. Needle aspiration.
Needle aspiration.

An incision is made in the vestibular area through an area of fluctuation (see image and video below). [12] Use a No. 11 blade to make a puncture 0.5-1 cm long into the abscess or cyst cavity on the mucosal surface of the labia minora. Make the incision within the hymenal ring, if possible. If Word catheter placement is planned, the incision should be just larger than the catheter diameter. If the incision is too large, the patient will not be able to retain the catheter for the desired time. Conversely, if standard incision and drainage is performed, the larger incision is important.

Incision of Bartholin abscess. Incision of Bartholin abscess.
Incision of Bartholin abscess.

Express the contents of the sac manually and use the hemostat to break adhesions (see image below). The contents may be sent for culture, and a suction system can be used to contain the manually-expressed fluids.

Drainage of a Bartholin abscess. Drainage of a Bartholin abscess.

Insert the tip of the Word catheter deep into the abscess cavity and use 2-4 mL of normal saline to inflate the balloon (see images and video below).

Insertion of a Word catheter. Insertion of a Word catheter.
Inflation of a Word catheter. Inflation of a Word catheter.
Insertion and inflation of a Word catheter.

Tuck the free end of the catheter into the vagina. In many cases, the free end changes its position to protrude outside the vagina (see image below). The catheter should stay in place for up to 4 weeks to allow epithelization of the tract. The patient should abstain from vaginal intercourse while the catheter is in place.

Word catheter in place. Word catheter in place.

The Word catheter may be left in place for several weeks to minimize the chance of recurrence. When healing is completed, a small permanent fistula is created in between the cyst cavity and the vestibular area. The size of the ostium is very small and scarcely visible with time. [12]


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