Encapsulated Hematoma of the Bartholin's Glandule.

Bartholin's glands are important organs of the female reproductive system. These glands have the function of producing an alkaline mucoid secretion, which helps in vaginal and vulvar lubrication. There are several types of lesions that can be identified in these anatomical structures, where in most cases presented for medical examination, cysts and abscesses predominate. This is the presentation of a clinical case of a 55-year-old patient, who is presented to the surgeon for her complaints. Once the woman is examined, diagnosed, and treated adequately, she is taken into consideration for presenting her case in this study, while maintaining confidentiality. The presented clinical case provides a clinical framework not easy to establish an accurate diagnosis of a Bartholin gland cyst. Careful physical examination by the surgeon and careful preparation with electrosurgery verified the cyst-hematoma left and just above the posterior fornix, where some material was taken from the cyst capsule and hematoma and sent for histological examination. The histological response concluded with cystic hematoma of the Bartholin gland. Cystic lesions of the vagina are relatively common and usually represent a benign condition. Ways of managing Bartholin gland cysts vary depending on the discomfort they bring to the patient as well as the size or even the anatomical extent of the cystic lesion. However, the physical examination, with a careful inspection by the surgeon, combined with the imaging examinations, requires a biopsy examination, which is the confirmation of the diagnosis.

Ultrasonography in the diagnosis of vulvar abscess.

This case image demonstrates the usefulness of vulvar ultrasound in the diagnosis of vulvar abscess.

A successful management algorithm for vulvar abscess: A tertiary hospital experience.

AIM: To develop a treatment and management algorithm for vulvar abscess. METHODS: We evaluated the clinical findings and treatment modalities of patients hospitalized with vulvar abscess via a comprehensive literature review and a clinical study. Patients with a diagnosis of vulvar abscess (n = 28) between 2015 and 2019 in the gynecology clinic of our hospital were included in the clinical study. Each patient's age, obstetric history, body mass index, presence of concomitant diseases, abscess culture and size, mean length of hospital stay, treatment modalities, and recurrence rate were recorded. RESULTS: The mean age and body mass index of the patients were 47.7 ± 11.5 years and 30.3 ± 2.7 kg/m2 , respectively. Diabetes mellitus was the most common concomitant disease (60.7%, n = 17). The abscesses of 22 (78.5%) patients drained spontaneously. The abscess cavities of the remaining six (21.4%) patients were treated via incisional drainage. Gentamicin + clindamycin or levofloxacin + metronidazole were used as the primary antibiotic treatment. Hemovac drains were placed in four (14.2%) patients with abscess sites greater than 5 cm. By applying our treatment methods, 26 (92.8%) of our patients were discharged with full recovery, and two patients (7.2%) were referred due to uncontrolled diabetes mellitus. The recurrence rate of vulvar abscess was 0%. CONCLUSIONS: This is the first study in the literature to present a successful algorithm for the treatment and management of vulvar abscess. Our treatment methods shed light on the treatment and management of vulvar abscess.

Vulvar Crohn's disease in an adolescent diagnosed after unsuccessful surgical treatment.

BACKGROUND: This case report presents a case of Vulvar Crohn's disease (VCD) in an adolescent, that is an uncommon manifestation of Crohn's disease (CD) without gastrointestinal symptoms. Before treating CD itself with proper medication, vulvar abscess continued to recur without improvement. CASE PRESENTATION: We report the case of an 18-year-old woman with VCD. After treatment with azathioprine 50 mg daily and mesalazine 1 g three times daily, vulvar lesions resolved after 6 weeks. We collected electronic medical data on patient characteristics, and evaluated findings of physical examinations, pelvic MRI, and biopsy specimen obtained from gastroduodenoscopy/colonoscopy. CONCLUSIONS: VCD is a rare manifestation of CD that may be misdiagnosed in the absence of gastrointestinal symptoms leading to delayed treatment. If a patient has an unexplained vulvar inflammatory lesion and with repeated failed surgical treatment, gynecologists should consider the possibility of a VCD.

Approach to Bartholin's abscesses and recurrences under office conditions.

OBJECTIVE: The aim of this study is to investigate the various treatment methods and recurrence rates regarding Bartholin's gland abscesses under office conditions in our clinic. METHODS: In our study, the data of 155 patients who applied to the gynaecology and obstetrics clinic of our hospital between January 2017 and November 2020 and had Bartholin's abscess that was treated with surgical methods under office conditions were analyzed retrospectively. RESULTS: Of the 155 patients included in the study, 111 underwent incision drainage, 22 underwent marsupialization, and 22 underwent incision drainage+ silver nitrate. Bartholin's abscess was localized on the right side in 48.4% of the patients and on the left side in 51.6% of the patients. Recurrence was detected in 53 of 155 patients included. Recurrence was detected in 39.6% of the patients who underwent incision drainage in the first treatment, 31.8% of those who underwent marsupialization, and 9.1% of those who underwent incision+silver nitrate. The difference in success, based on recurrence rates, was found to be statistically significantly in favour of silver nitrate (p<0.05). In secondary treatments for recurrent cases, marsupialization or incision+silver nitrate treatment was effective in over 90% of cases, while incision drainage was effective in 30% of patients. CONCLUSION: The findings of our study show that silver nitrate application led to a lower recurrence rate than the other two methods. In view of this, we recommend that marsupialization or silver nitrate be preferred, especially in the treatment of recurrent cases.

Gangrena de Fournier vulvar relacionada con prolapso uterino total / Vulvar Fournier gangrene related to a total uterine prolapse

Resumen ANTECEDENTES: La gangrena de Fournier es una fascitis necrotizante polimicrobiana, de comienzo agudo y rápida progresión. Afecta los genitales externos, el periné y la región perianal y es de elevada mortalidad. Es diez veces más frecuente en varones, sobre todo, en los de 50-60 años. Entre los factores de riesgo conocidos están: diabetes mellitus, hipertensión y alcoholismo. CASO CLÍNICO: Paciente de 62 años, con diabetes mellitus tipo 2 de larga evolución, hipertensión y obesidad, sin exploraciones ginecológicas previas, que consultó por fiebre, dolor abdominal y perineal. Se le diagnosticó gangrena de Fournier vulvar, quizá originada por una erosión vulvar, producida por el prolapso genital total. La exploración (absceso vulvar crepitante) y las pruebas de imagen ayudaron a establecer el diagnóstico. El tratamiento se inició con antibiótico de amplio espectro, por vía intravenosa, seguido de intervención quirúrgica urgente para desbridamiento amplio del tejido necrótico. Debido a la rápida propagación de la fascitis, la paciente fue reintervenida 48 h después. El aislamiento de anaerobios y Streptococcus constelatus en los tejidos, junto con el estudio histológico, confirmaron el diagnóstico definitivo. El posoperatorio evolucionó favorablemente. CONCLUSIONES: La gangrena de Fournier es un padecimiento poco frecuente y en la mujer la clínica es más insidiosa. Conocer los factores de riesgo y los síntomas iniciales puede ayudar a establecer el diagnóstico y tratamiento más temprano, permitir intervenciones quirúrgicas más conservadoras, aumentar la supervivencia y mejorar el pronóstico de las pacientes. El buen control de la diabetes, su principal factor de riesgo, es decisivo para su prevención.

Abstract BACKGROUND: Fournier´s gangrene is a polymicrobial necrotizing fasciitis, with acute onset and rapid progression. It affects perineal, perianal and genital regions and it has a high mortality rate. It is 10 times more frequent in men than in women, with highest incidence amongst patients aged 50 to 60. Its known risk factors include diabetes mellitus, hypertension and alcoholism. CLINICAL CASE: A 62-year-old woman with type II long-standing diabetes mellitus, hypertension and obesity, without previous gynecological exams was hospitalized with fever, abdominal and perineal pain. She was diagnosed with vulvar FG, probably caused by a vulvar erosion, produced by the total genital prolapse presented. Exploration (crepitant vulvar abscess) and imaging tests helped the diagnosis. Broad-spectrum intravenous antibiotics therapy was initiated, followed by an urgent surgical procedure in which a debridement of the necrotic tissue was performed. Due to spreading of the infection, the patient had to be reoperated 48 hours later. Streptococcus Constelatus and anaerobes were isolated from tissues and an anatomopathological study confirmed the diagnosis. Postoperative care ended favorably. CONCLUSIONS: Fournier's gangrene constitutes a very rare pathology, especially in women due to a more insidious clinic. Knowing about the risk factors and initial symptoms, can help to make an early diagnosis and apply urgent treatment, allowing more conservative surgeries, increasing the survival and improving the prognosis. The right handling of diabetes, its main risk factor, becomes key in the prevention of this pathology.

A 14-year-old girl with recurrent vulvar abscess.

BACKGROUND: Inflammatory bowel disease is a relatively common condition that may present in a myriad of fashions, from the more frequently seen symptoms of diarrhea and abdominal pain to the less likely presentations with fistulas and abscesses. CASE: A 14-year-old female with a presumed diagnosis of a Bartholin's gland cyst was treated for over 1 year with both medical and surgical interventions without her symptoms ever completely resolving. It was later found that these recurring vulvar abscesses were a manifestation of Crohn's disease. CONCLUSION: While the patient's history and physical are both very important in determining cause for pathology, we must also realize the importance of re-examining and broadening our differential diagnosis when faced with a patient who has failed multiple avenues of care.

Infantile Vulvar Abscess with a Normal Anus: A Suspicious Sign of Rectovestibular Fistula

PURPOSE: We investigated whether infantile vulvar abscesses are predictable features of rectovestibular fistula with a normal anus. MATERIALS AND METHODS: A retrospective analysis of five infants with vulvar abscesses and rectovestibular fistulae with normal anuses was performed. RESULTS: Four cases had a left vulvar abscess, and in one case the vulvar abscess was on the right side. All caregivers reported passage of stool from the vagina. The fistulae were almost uniformly located from the vestibule to the rectum above the anal dentate line, observable by visual inspection and probing under anesthesia. The first two cases were treated with division and closure of the fistulae after a diverting loop colostomy, and the remaining three cases with fistulotomy and curettage. There was no recurrence during the median follow-up period of 38 months. CONCLUSION: This unique rectovestibular fistula should be suspected in female infants with vulvar abscesses, especially when parents report passage of stool from the vagina. Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.