Huge Bartholin’s cyst managed by primary marsupialization:A case report

BACKGROUND We report on the case of a 21-year-old female who could not walk due to a huge Bartholin's cyst occupying the right vulvar region.The patient was treated by marsupialization of the Bartholin’s cyst and postoperative antibiotic therapy.CASE SUMMARY A 21-year-old female without a medical history of sexually transmitted diseases presented to our outpatient clinic with complaints of a painful vulvar lump and a green-yellowish discharge for 4 d.A large Bartholin’s cyst,10 cm in diameter,was suspected over the right side of the vulva.She was advised to be admitted to the ward for intravenous antibiotic treatment and to perform marsupialization several days later.However,the patient requested immediate surgery because of time limitations.The patient underwent marsupialization under local anesthesia.The procedure was well-tolerated.After making the incision,a significant amount of malodorous pus(approximately 30 mL)was removed from the abscess.The patient was followed up for 1 wk postoperatively.The Bartholin’s cyst regressed,and the surgical wound healed well.CONCLUSION Our case shows that an initial marsupialization followed by oral antibiotic therapy can be an appropriate treatment option for a large Bartholin’s cyst.However,depending on the patient’s condition,a suitable treatment,either cystectomy or marsupialization,can be considered.

Hemorrhagic Bartholin’s cyst in a woman using anti-platelet medication:A case report and review of the literature

BACKGROUND We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who has been using an antiplatelet medication.CASE SUMMARY A postmenopausal woman,84 years of age,had a medical history of hypertension,diabetes mellitus,coronary artery disease(three-vessel disease),chronic kidney disease(stage 3),and dementia.The patient has been taking clopidogrel,an antiplatelet medication,for several years.She presented at our outpatient clinic complaining of painful swelling over her left vulva for several days.A Bartholin’s cyst over the left vulva was suspected,and the patient underwent marsupialization under local anesthesia,which was well-tolerated.During the incision procedure,bright-red blood with some blood clots was discharged,and a hemorrhagic Bartholin’s cyst was observed.There was no recurrence of the hemorrhagic Bartholin’s cyst during the 6-mo subsequent follow-up period.CONCLUSION Hemorrhagic Bartholin’s cysts rarely occur.We report the case of a postmenopausal female with a hemorrhagic Bartholin’s cyst who had been on antiplatelets and was successfully treated with marsupialization.No recurrence was noted during the 6-mo follow-up period.Older females taking antiplatelets should be cautious of bleeding when presenting with a Bartholin’s cyst.

“Management of Bartholin Cysts and Abscess” in a Tertiary Care Centre, Jeddah, Saudi Arabia

Objective: To analyse all cases of Bartholin glands pathology (cysts and abscess), and identify the different variable affecting the method of management with Marsupialization or excision. Methods: This study is a cross-sectional retrospective analysis of all cases of Bartholin cysts and abscess admitted and managed at KAUH, from January 2017 to December 2017. Results: 48 patients were analysed: age (32.60 ± 9.9), parity, BMI (26.9 ± 4.98). Out of 48 patients, 25 (52.1%) were diagnosed as Bartholin cysts and 23 (47.9%) as Bartholin abscess. 72.9% (35) patients were managed with Marsupialization, and only 27.1% ended with excision. Comparing age in years, parity and BMI in the cases managed by Marsupialization with those with excision, the only statically significant difference was found in the parity. When comparing the important factors collected, younger subjects less than 35 years old, never being pregnant and BMI less than 30 had more Marsupialization than excision. But age . Abscess and non-recurrent had more Marsupialization but were statistically not significant. Other factors, past medical and surgical history and type of anaesthesia were the same in both groups. Logistic regression performed using the dependent variable for Marsupialization rather than excision with different covariant categorised variable, age less than 35, single, abscess, non-recurrent, and BMI less than 30 (Table 2). Age less than 35 and BMI less than 30

Incidence, Presentation and Management of Bartholin’s Gland Cysts/Abscesses: A Four-Year Review in Federal Teaching Hospital, Abakaliki, South-East Nigeria

Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin’s gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin’s gland cysts and abscesses in FETHA. We studied all cases of Bartholin’s gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1st January 2012 to 31st December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin’s gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin’s gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin’s gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.

Management of abdominal and pelvic abscess in Crohn's disease

Patients with Crohn's disease may develop an abdominal or pelvic abscess during the course of their illness.This process results from transmural in ammation and penetration of the bowel wall,which in turn leads to a contained perforation and subsequent abscess formation.Management of patients with Crohn's related intra-abdominal and pelvic abscesses is challenging and requires the expertise of multiple specialties working in concert.Treatment usually consists of percutaneous abscess drainage(PAD)under guidance of computed tomography in addition to antibiotics.PAD allows for drainage of infection and avoidance of a two-stage surgical procedure in most cases.It is unclear if PAD can be considered a definitive treatment without the need for future surgery.The use of immune suppressive agents such as anti-tumor necrosis factor-α in this setting may be hazardous and their appropriate use is controversial.This article discusses the management of spontaneous abdominal and pelvic abscesses in Crohn's disease.

Beh et's disease complicated by multiple aseptic abscesses of the liver and spleen

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.

Adenoid cystic carcinoma of the Bartholin's gland:a case report and review of the literature

Adenoid cystic carcinoma(ACC) of the Bartholin's gland is a rare malignant tumor of vulvar which is characterized by slow growth,local invasion and perineural infiltration.The survival rates for 10 years range from 50% to 100%.The disease free interval for 10 years range from 33% to 38%.Currently,there is no consensus on the treatment of ACC of the Bartholin's gland.Primary surgery includes wide local excision or radical vulvectomy with or without lymph node dissection.Adjuvant radiotherapy and chemotherapy are advocated for the treatment of this cancer.Work is still needed to identify an effective systemic therapy.

Reduction of Beta-Lactam Antimicrobial Activity in <i>Staphylococcus aureus</i>Abscesses by Neutrophil Alteration of Penicillin-Binding Protein 2

We previously demonstrated that brief nonkilling neutrophil exposure diminishes the binding affinity of S. aureus penicillin-binding protein (PBP) 2. We sought to investigate further the role of the neutrophil in the alteration of antimicrobial activity and its interaction with PBP-2 by studying the activity of cefotaxime, which highly binds to PBP 2, and cephalexin, which minimally binds to PBP 2. Using S. aureus, cultured in vitro in sterile-filtered normal and neutrophil depleted abscess fluid, we sought to demonstrate an in vivo significance of the neutrophil effect upon the activity of antimicrobials that target PBP-2 by studying the same antimicrobials in an experimental S. aureus abscess. Rats were implanted with perforated tissue cages and infected with S. aureus;some rats were neutrophil depleted by mechlorethamine. Abscess fluids from normal and neutropenic abscesses were harvested, pooled, sterile-filtered and stored for the time-kill studies. Treatment studies were performed by administering either 300 μg/kg/d cefotaxime or cephalexin for 7 days in other rats with 24 hour-old tissue-cage S. aureus abscesses. In time-kill studies, cefotaxime was highly active against stationary phase S. aureus in MHB and in neutropenic abscess fluid, but less active in the non-neutropenic abscess fluid (p 10 kill, p = 0.029 vs. 0.81 ± 2.5, p = NS). These data suggest that neutrophil exposure, which diminishes S. aureus PBP-2 binding affinity [or total quantity], also adversely affects the antimicrobial activity of cefotaxime, which binds to PBP-2, as compared to cephalexin. Altered PBP targets from neutrophil exposure may be a mechanism of antimicrobial resistance within abscesses.

Meckel's diverticulum manifested by a subcutaneous abscess

This case report describes an extremely rare complication of a Meckel's diverticulum:enterocutaneous fistula of the diverticulum.The presence of Meckel's diverticulum is a well known entity,but subcutaneous perforation of the diverticulum is very rare.Here we report the case of a patient with the complaint of a right lower quadrant abscess,preoperatively diagnosed as enterocutaneous fistula,which was determined intraoperatively to be a fistula resulting from Meckel's diverticulum.

Bartholin’s Gland Carcinomas: A 20 plus-year experience from Queensland

Objective: To review the records of cases of Bartholin’s Gland Carcinoma referred to the Queensland Centre for Gynaecological Cancer (QCGC) between mid 1993 and mid 2012. Methods: Bartholin’s Gland Carcinoma case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences 11.0. Results: Of the 12 cases four died of their disease, seven are still alive and disease free and one is alive with recurrent disease. The mean age at diagnosis was 52.8 years. Time from onset of symptoms to diagnosis averaged 5.8 months. All diagnoses were confirmed histologically. Presenting symptoms included a lump and pain. The most common presenting complaint was a lump. Treatment included surgical excision, occasional biopsy followed by radiotherapy with or without chemotherapy. In some cases radiation and chemotherapy was followed by vulvectomy of various extent. Conclusions: Bartholin’s Gland Carcinoma is a rare condition with outcome dependent on duration of symptoms, including delay in diagnosis, cell-type, cellular differentiation and the International Federation of Gynecology and Obstetrics (FIGO) classification. A Bartholin’s gland mass in a woman aged 40 years or more should be considered malignant until a biopsy proves otherwise.The incidence of Bartholin’s Gland Carcinoma in Queensland is less than that reported elsewhere but a higher proportion of squamous cell carcinomas was found in this small series.

An Extensive Cholesteatoma with Bezold’s Abscess

Cholesteatoma has been known to be associated with multiple complications either extracranially or intracranially. Among the extracranial complications, mastoiditis and mastoid abscess are the most common. Bezold’s abscess formation with cholesteatoma is a rare occurrence but when present can lead to sinister sequalae if not properly managed. The treatment of cholesteatoma is mainly by surgical exploration namely mastoidectomy. The aim of treatment is to eradicate the diseased mastoid and to prevent subsequent complications. Beside surgical intervention, the patient will also require intensive systemic and topical antibiotic therapy. With proper treatment patient will be hindered from experiencing unwanted complications.

Case of Unusual Abscess Localization in Lumbar Pott’s Disease

In Pott’s disease, cold abscesses usually sit and spread along the psoas muscle. This case concerned a 60 years old man who came to us with bilateral lomboradicular pain and a swelling of inguinal area and the anterior part of the left thigh. We found a 2 years long lasting story of low back pain complaint. Physical examination showed good general health status, stiffness of lumber spine, a left psoitis and no neurological deficit. CT scan going downward from the lumbar spine to the pelvic region and femoral limb with coronal reconstruction demonstrated a huge disco-vertebral destruction of L2-L3 with translation, and bilateral paramedian psoas abscess migrating subfascially toward Scarpa triangle and cleaving anteriorly mainly muscles of the left thigh. After 12 months medical treatment, the evolution has been favorable with clinical cure. The localization of the cold abscess in the left thigh anterior muscles compatment is uncommon. It is why we report this case.

Long-Term Efficacy Analysis of Exclusive Enteral Nutrition for the Treatment of Abdominal Abscess in Crohn’s Disease

Objective: The objective is to explore the long-term efficacy of total enteral nutrition in the treatment of abdominal abscess in Crohn’s disease. Methods: Patients treated with EEN in our hospital and whose abdominal abscess disappeared after 12 weeks of treatment were included, and the data of abscess recurrence and surgical treatment during follow-up were included. Results: A total of 44 consecutive cases meeting the criteria were included. The 1-year and 2-year recurrence rates were 22.5% and 39.9% respectively. Among the patients with recurrence, 10 patients chose EEN treatment again, and 5 patients received direct surgical treatment. Of the patients who chose to undergo EEN treatment again, 8 still eventually required surgery. The 1-year operative rate was 16.9%, and the 2-year operative rate was 35.6%. The median operative time was 33.3 (95% CI: 21.3, 45.4) months. Conclusions: The 2-year cumulative incidence of recurrence of abdominal abscess in CD patients whose abdominal abscess disappeared after EEN was 39.9%, and the 2-year cumulative surgical rate was 35.6%. The operative stomy rate decreased after EEN, and the primary anastomosis rate increased significantly.

Brodie's骨脓肿

本文报告Ｂｒｏｄｉｅ＇ｓ骨脓肿１２例诊治经验。病灶均位于长骨干骺端，１０例有轻微疼痛，全部病例白细胞总数及分类计数均在正常范围。Ｘ线示长骨干骺端近圆形孤立透光区，边缘清晰，周缘可见硬化环。８例细菌培养阴性。均采用病灶刮除。１１例植骨，１例用羟基磷灰石填塞。随访未见复发。术前误诊３例。本文目的在于引起临床上对该病的足够认识，减少误诊机会。

难治性克罗恩病肛瘘合并严重感染的成功管理经验总结(1例报告)

目的总结1例克罗恩病肛瘘合并肛周脓肿的重症患者的治疗与护理经验。方法回顾性分析中山大学孙逸仙纪念医院消化内科收治1例克罗恩病肛瘘合并肛周脓肿患者的临床治疗资料。结果患者经内科治疗与护理65天后情况好转出院。结论克罗恩病合并肛瘘、肛周脓肿,临床治疗棘手,治疗成功的关键在于多学科联合治疗及个体化管理措施。

Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease

Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.

Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn's disease?

AIM:To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn's disease(CD).METHODS:Patients with perianal disease(abscesses,fistulas,recurrent fissures) were evaluated for underlying CD.Patients who had a negative work up,defined as a negative colonoscopy with a normal ileoscopy or a normal small bowel series or a normal CT/MR enterography,underwent a Pillcam study of the small bowel after signing informed consent.Patients using nonsteroidal anti-inflammatory drugs or who had a history of inflammatory bowel disease or rheumatic disease were excluded.RESULTS:We recruited 26 patients aged 21-61 years(average 35.6 years),17 males and 9 females.One case could not be evaluated since the capsule did not leave the stomach.In 6 of 25(24%) patients with a negative standard work up for Crohn's disease,capsuleendoscopy(CE) findings were consistent with Crohn's disease of the small bowel.Family history of CD,white blood cell,hemoglobin,erythrocyte sedimentation rate or C-reactive protein did not predict a diagnosis of CD.Capsule endoscopy findings led to a change in treatment.CONCLUSION:In patients with perianal disease and a negative conventional work up to exclude CD,CE leads to incremental diagnostic yield of 24%.

套管针治疗前庭大腺囊肿疗效观察

目的探讨套管针治疗前庭大腺囊肿的临床效果。方法选择年龄22～45岁,囊肿直径2～4 cm的患者18例,其中囊肿16例,脓肿2例。均为单侧。常规消毒后于前庭大腺开口处或近前庭大腺开口处,用套管针穿刺、抽液并冲净嚢腔,保留套管针。穿刺术后,会阴冲洗、阴道上药、经套管针冲洗嚢腔并转动套管针,均1次/d,此外,脓肿者静脉滴注抗生素1周,7 d后撤套管针、停阴道上药及静脉滴注抗生素,每日用温开水清洗外阴,禁止性生活,强调预防感染。结果 16例囊肿患者3 d治愈,2例脓肿患者7 d治愈。1个月复查,随访2年,均无复发。结论套管针治疗前庭大腺囊肿或脓肿,方法简单,损伤小,且能保持前庭大腺原有形态和功能。

前庭大腺囊肿和前庭大腺脓肿102例的治疗观察

目的比较以引流条造瘘和传统造口术,治疗前庭大腺囊肿和前庭大腺脓肿的疗效。方法102例患者,分为2组:引流条造瘘组以橡皮引流条贯穿于囊肿或脓肿壁两造口之间建立人工瘘道;传统造口术组按传统的前庭大腺囊肿或脓肿造口术进行。结果引流条造瘘组成功率98.6%,随访最长8年,仅1例复发,疗效比传统造口术组明显提高。结论引流条人工造瘘是一种安全、经济、有效的治疗前庭大腺囊肿和前庭大腺脓肿的方法。

套管针法治疗前庭大腺脓(囊)肿22例临床分析

观察22例套管针法治疗前庭大腺脓(囊)肿的效果,治愈率100%,随访5～12月,无复发.套管针法治疗前庭大腺脓(囊)肿(尤其是3.0 cm以下)疗效满意.