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BARTHOLIN’S ABSCESS

By : Nova Rukmala Dewi (110 208 0096)

ADVISOR:dr. Suci Nugraeni

SUPERVISOR:dr. Widya Widita Sp.KK M.Kes

DEFENITION

Bartholin’s Abscess glands is abscess that happens when bartholin glands are obstructed. Bartholin’s glands can be obstructed because of some reasons, such us infection, inflammation or long term irritation.

Bartholin’s Abscess

EPIDEMIOLOGI

Disease that attacks bartholini glands usually happen to women around 20 - 30 years old. Swelling Bartolini glands of patient more than 40 years old are seldom to be found, and need to be consultated to gynecologist so can be done a biopsy.

ETIOPATOGENESIS

Cause of abnormality Bartholin’s glands is obstructed part of distal from ductus glands that cause retention from secretion, ductus dilatation happens and forms cyst. If these glands get infection for long time can effects formed bartholin’s cyst and than grows to become abscess. Bartholin’s abscess is not only because of cyst which gets infection, but also because of direct infection on bartholin’s glands. Microbe which often infects bartolin’s gland is Neisseria gonorrhoeae.

CLINICAL INDICATION

Painful when walking and sitting, Painful which suddenly

abated

Extreme painful which follows swelling unilateral labial

Dispareunia

Discharge appearance ( very possible indicates

there is spontaneus ruptur from abscess)

DIAGNOSIS

ANAMNESIS AND PHYSICAL CHECK

Diagnosis begins from anamnesis and physical check, manifestation of clinic from bartolini’s abscess includes extreme painful. System around ( connection between middle side and down side of labia minora) gets inflamation and edema. In physical check, introitus of vagina usually changed looks there is fluctuation mass in palpation check. Very seldom sistemic indication and presents infection be reported.

SUPPORT CHECK

In Bartolin’s abscess probably also be required smear check (pap smear) or culture check for bacteryology check specificly. However as long as indication which be found in anamnesys and physical check, culture check is seldom to be done.

If patient in health condition, blood laboratory check is not be required to evaluate cyst or abscess. If it has been abscess, bacterial culture can be useful to determine microbe and appropriate treatment.

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COMPARISON DIAGNOSIS

• Location: usually on labia mayora.• Characteristics: Benign, mobile,

nontender, cause of trauma or obstruction from polisabaseus duct. getting infection, be inquired insition and simple drainage .

Epidermal

inclusion cyst

• Location: labia minora, vestibuli, periclitoral area

• Characteristics: Soft consistence, diameter is less than 2 cm, flat surface, located in superfisial, soliter or multiple, usually asimptomatic.

Mukosa vestibuli

cyst

• Location: between majora labium and minora labium.

• Characteristics: Transparant, slow growth, small nodules (2 mm - 3cm), grows from apocrin sweat glands. Need be concidered to be done a biopsy if blooding happens and removed it if there is indication.

Hidradenoma

papilliferum

• Location: Near from meatus urethrae in vestibuli.

• Characteristics: Transparant. Asimptomatik, if getting bigger will cause obstruction in urethra and happens urine retention.

Skene’s duct cyst

MANAGEMENT OF IMPLEMENTATION

Treatment of bartholin’s cyst and bartholin’s abscess one of them is surgery treatment , includes insition and drainage, marsupialization.

WORD CATHETER

Word catheter was found first time in 1960’s. it’s a small catheter with ballon which can be bloated up with saline on the end of distal. usually it’s used to threat cyst and bartholin’s abscess.

MARSUPIALIZATION

Marsupialization from bartholin’s gland commonly is done if there is big abscess which causes difficult operation of gland excition . In this surgical operation, surgeon will open widely abscess’ membranes so that enable to bring out purulent exudate. Abscess membranes be sewn to mucosal of vagina and skin on introitus vagina for granulation effect and reepitelisation from bottom wound to top of abscess. Purpose of bartholin’s glands marsupialization is to remove abscess such that will happen epitheliasation on the bottom.

EXCISON

Excision from Bartholin’s gland can be considered to patient who does not response drainage, however this procedure must be done when there is no active infection.

DRUG TREATMENT

Antibiotic as empirical therapy to treat sexual transmitted disease is used to treat gonococcal infection and chlamydia. Ideally, antibiotic must be given before incision and drain be done.

COMPLICATION

Some cases Bartholini’s abscess usually relapses. Blooding especially for koagulopati patient. scarring system rises.

PROGNOSIS

If abscess with drainage treatment and avoid recurrence, the prognosis is well. Level of relapse mostly be reported under 20%.

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THANK YOU…