Jacobi ring catheter outpatient treatment of the Bartholin gland abscess: a case report

Abstract

The optimal surgical technique for the treatment of Bartholin duct cysts and gland abscesses has not been finally chosen. Currently, the following methods are used: needle aspiration, with or without alcohol sclerotherapy; silver nitrate cyst ablation; use of laser technique; fistulization using Word catheters, Foley catheters, or Jacobi rings; incision and drainage followed by primary suture closure; cyst marsupialization; and cyst excision.

This article describes a clinical case of Jacobi ring catheter outpatient treatment of a Bartholin gland abscess. A 8 Fr/Ch silicone coated latex Foley catheter was used to make the Jacobi ring catheter. The catheter was inserted into the abscess cavity through two separate incisions, forming a closed rubber ring after tying a USP 4/0 polypropylene thread passed through the catheter channel. The operation was performed in the office. We used local infiltration anesthesia with 2 ml of 2% lidocaine solution. The patient was prescribed oral antibacterial therapy with amoxicillin (875 mg) and clavulanic acid (125 mg) twice a day for five days and the use of ointment with dioxomethyltetrahydropyrimidine (40 mg) and chloramphenicol (75 mg) topically. The pain was relieved immediately. The abscess cavity was drained perfectly by the Jacobi ring catheter, which did not cause discomfort to the patient. Clinical signs of inflammation disappeared within a week. The patient’s activity, including sexual one, was not limited. The Jacobi ring catheter was removed after four weeks. However, four months later, the patient returned due to formation of a Bartholin duct cyst. Since there were no signs of inflammation, authors performed marsupialization.

This clinical case demonstrated the convenience of using the Jacobi ring catheter for the treatment of the Bartholin gland abscess in the office: the technique is easy to perform, with specific instruments and devices not required, and allows for rapid relief of disease symptoms and reliable and long-term drainage of the abscess cavity. The technique is recommended to leave the Jacobi ring catheter for at least six to eight weeks. That may be the possible key to preventing recurrences, the possibility of which the patient must be warned about. However, this applies to any method of treating Bartholin duct cysts and gland abscesses.

Keywords

large gland of the vulvar vestibule / Bartholin gland / cyst / abscess / bartholinitis / marsupialization / fistulization / Word catheter / Jacobi ring

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