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Bartholin's Abscess & Vaginal FB's - Dr. A. Hunt

8/24/2017

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Picture
Bartholin Abscess
General
  • Bartholin’s Gland is a pea sized glands located at the 4 and 8 o’clock positions of the vaginal vestibule, tasked with maintaining moisture of the vestibular surface.
  • Can develop into cysts or abscesses (3x more common) with no overwhelming predisposing factors. Majority are polymicrobial but could be gonorrhea/chlamydia in origin.
Management
  • Conservative MGMT = Sitz baths if <2cm and pt not immunocompromised
  • Gold standard for management is I&D plus drainage device placement (Word catheter vs Loop)
  • Word catheter highlights: Keep the cut small! 5mm, instill with approx. 3cc saline, tuck stalk into vagina for comfort
  • Loop Drain highlights: Vessel loops or wrist loop of a sterile glove in resource poor environment, 2 incisions made at opposite ends of abscess, 2nd incision made with clamp tip as a marker internally, clamp exits 2nd incision and grasps loop material, pull through and tie ends together. Avoid excess tension that would cause pressure necrosis.
  • Aftercare: Guard Word catheter from excess manipulation. Slide loop drain back and forth 2x per day. Sitz baths encouraged.
  • Antibiotics IF: -Recurrent Bartholin abscess, Extensive surrounding cellulitis, pregnancy, immunocompromised, Culture-positive MRSA, Signs of systemic infection (eg, fever, chills).
  • Antibiotic regimen - 1st line = trimethoprim-sulfamethoxazole DS tablet BID x 7days. Second line = Augmentin + clindamycin, 2nd or 3rd gen cephalosporin or fluoroquinolone, PLUS clinda or doxy.
Follow up
  • Goal is to allow for tract formation, Word catheter recommendation is 4-6 weeks and Loop Drain has same time course or wound recheck at 3 weeks.

Vaginal Foreign Bodies
  • If you don’t keep it on your differential, you will miss it! Keep in mind in both adult and pediatric populations, can be common in mentally handicapped children.
  • Suspect when in cases of foul smelling vaginal discharge +/- vaginal bleeding, recurrent UTIs or vaginitis presentations, premenarchal vaginal bleeding
  • More common objects: Adults – tampons, condoms; Pediatrics – toilet paper, toys, safety pins, pencil, crayons, erasers, coins.  
  • Diagnosis via direct visualization, plain film, transvaginal vs. transperineal US, vaginography, MRI.
  • Treatment is removal
  • In pediatrics you can try:
- Examine external genitalia (knees to chest) and remove any obvious partially inserted objects
- Instill saline, irrigate
- Pediatric speculum or nasal speculum
- May require general anesthesia

**Do not forget potential sexual abuse in either population**

  • Know when to consult GYN. Complications such as rectovaginal, rectovesicular fistulas CAN occur.

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    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Incentive Shifts & Moonlighting >
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      • STICU Moonlighting
      • MICU X moonlighting
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        • Union Cardiac Rehab
    • Schedules >
      • Block Schedule
      • ED Shift Schedule
      • Conference and Resident Lectures
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      • CQR
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
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      • Resume Builder
    • Individualized Interactive Instruction
    • Off Service Rotators