Abscess of bartolinovy gland
Abscess of bartolinovy gland is the delimited purulent process with involvement of a parenchyma of big gland of a threshold of a vagina (true abscess) or cavities of its channel (false abscess). The disease is shown by volume education in the field of the lower third of a big vulvar lip, intensive local pain, temperature increase of a body, a general malaise. The diagnosis is exposed by results of survey of the gynecologist, a bacteriological research, the analysis of PTsR. Treatment surgical – opening of abscess with the subsequent drainage, a marsupialization of the suppurated cyst or an extirpation of gland.
Abscess of bartolinovy gland
Abscess of bartolinovy gland (abscess of big vestibular gland) – the localized purulent infection affecting one (it is rare - both) from pair ferruterous bodies. These glands settle down in the thickness of vulvar lips and carry out function of an exogenous sekretirovaniye – produce the viscous liquid moisturizing genitalia and protecting them from infections. Diseases are subject women of the genital period (20-40 years), incidence makes 2%. In gynecology it is necessary to observe a false abstsedirovaniye of big vestibular glands more often. Bilateral abscess usually is a consequence of gonorrhea. Bartolinov abscess does not develop at children, seldom is registered at teenage and advanced age and is extremely rare – in senile.
Reasons of abscess of bartolinovy gland
The disease has infectious character and most often arises as gland inflammation complication - a bartolinita. From specific activators allocate , a trichomonad, a hlamidiya, from nonspecific – opportunistic representatives of obligate and facultative flora: staphylococcus, streptococci, colibacillus, mushrooms, anaerobic bacteria. Anaerobic microorganisms (bakterioida, peptokokk, peptostreptokokk, are more rare - klostridiya) are sowed from the purulent center in 80-90% of cases and are the most frequent cause of illness.
Most often the infectious agent gets into a bartoliniyeva to iron from a vulva epithelium, from adjacent hollow bodies – vaginas, urethras, a rectum at non-compliance with rules of personal hygiene and diseases (a bacterial vaginosis, a vulvita, a vaginita, a tservitsita, an adneksita, an uretrita, a proktita, enteritis, an enterobioza), and also from the outside – at sexual contact. Other sources of infection - badly processed medical tool, dirty hands, the general towels. Very often recurrent abscesses develop against the background of a retentsionny cyst of the bartolinovy gland which is the ideal tank for growth of opportunistic flora.
Inflammatory process or existence of a cyst attracts suppuration not at all patients. Tendency of an organism to an abstsedirovaniye is caused first of all by immune insufficiency. Endocrine and exchange diseases (diabetes, a hypothyroidism), the centers of a chronic infectious inflammation (tonsillitis, sinusitis, caries, bronchitis, cholecystitis), a gelmintny invasion, deficiency of vitamins B a diet most often lead overcooling, chronic overfatigue, a long stress, abuse of alcohol, treatment of cytostatics and corticosteroids to such state. It is possible to refer wearing the close clothes squeezing area of a small pelvis and crotch (trousers, underwear), self-treatment of a bartolinit to the contributing factors (for example, hot bathtubs).
As gate of an exogenous infection serves the output channel of bartolinovy gland, the infectious agent can get to a parenchyma in the hematogenic way. Penetration of the activator causes the inflammation of a mucous membrane which is expressed hyperaemia, an ekssudation and violation of microcirculation that leads to its hypostasis and narrowing of a gleam of the main channel. As a result of a slushchivaniye and an ulceration of the top layer of an epithelium there can occur obstruction of the mouth and (or) adhesion of walls of a channel. These changes attract stagnation of purulent exudate with further distribution of pathological process on a parenchyma of bartolinovy gland, soft tissues of a vulvar lip and vagina, okolovlagalishchny cellulose.
Purulent infiltration of gland and the next structures leads to formation of abscess: at first leykotsitarny enzymes melt fabrics with formation of the cavity filled with pus then around a cavity the cover is formed of granulyatsionny fabric – a demarcation shaft (a piogenny membrane). At synchronization abscess becomes covered outside by a layer of connecting fabric. The capsule surrounding an abscess does not interfere with organism intoxication disintegration products, however significantly complicates penetration of antibacterial medicines from a blood-groove.
Allocate two forms of purulent pathology of bartolinovy gland: false (pseudo-abscess) and true abscess. Pseudo-abscess can independently exist a long time, without leading to defeat of a parenchyma of gland, or later short time to pass into true abscess: the course of pathology in many respects depends on virulence of the activator and the immune status.
- False abscess (empiyema). Is followed by a pus congestion in a gleam of the main channel of bartolinovy gland. Purulent inflammatory process does not extend to gland parenchyma, being limited to a mucous membrane of the removing channel. Empiyema is in most cases called by rapid growth of opportunistic anaerobic microflora in the conditions of stagnation of a secret and often develops against the background of is long the existing retentsionny cyst. Pseudo-abscess is registered more often than true.
- True abscess. Often arises at infection of piogenny cocci with association (gonokokk and pathogenic stafilokokk, streptococci), it is characterized by infiltration of gland and adjacent soft fabrics with their subsequent purulent fusion and education around the center of an inflammation of a demarcation shaft. At an endogenous infection true abscess can develop without the previous obstruction of the removing channel.
Symptoms of abscess of bartolinovy gland
Characteristic symptom of abscess of big glands of a threshold – volume (reaching the egg sizes), as a rule, unilateral education in the field of an average and lower third of a vulvar lip. Purulent process is followed by increase and morbidity of inguinal lymph nodes. At an empiyema against the background of the expressed hypostasis and hyperaemia of a mucous membrane of a threshold of a vagina, big and small vulvar lips the roundish, not soldered to the next structures swelling of an elastichesky consistence, partially or completely blocking an entrance to a vagina is observed.
At true abscess there is also considerable swelled on the party of defeat, education is inactive, has no clear boundary, is fixed to strongly hyperemic skin. The expressed pain syndrome is characteristic of abscess of bartolinovy gland. The acute pain in a vulvar lip irradiating in a hip interrupts a sleep, amplifies when walking, sitting, cough, defecation and is a little weakened only in the compelled horizontal position on a back with the moved apart legs.
True abscess distinguishes a sharp clinical current: except pain the loss of appetite, tachycardia, lowering of arterial pressure, weakness are noted the exhausting fever (often with a fever). The all-somatic symptomatology of pseudo-abscess is expressed not so brightly, only temperature increase to 38 °C and an insignificant general malaise is quite often observed. Both at true, and at false abscess after opening of an abscess (or break outside) there comes sharp simplification of a state.
Chronic (recidivous) purulent bartolinit is shown by periodic maturing and opening of pseudo-abscesses. The period of remission is characterized by existence in more thickly vulvar lip of dense, inactive and almost painless education, and also discomfortable feelings at sexual excitement, in time and after sexual intercourse. At aggravations all symptoms of sharp abscess are shown.
Spontaneous opening of a bartolinov of abscess can lead to formation of fistula with its subsequent scarring and deformation of a vulvar lip, and also walls of a vagina and rectum – in case of break of an abscess in their cavity. Not healing rektovaginalny fistulas with throwing of kalovy masses in a vagina gleam at the big extent of defect can sometimes be formed. Other failure of abscess – break in surrounding cellulose with development of the poured purulent process - phlegmons of a crotch or, at hit of the infectious agent in a blood-groove, generalized purulent process – the sepsis starting a number of the biochemical reactions which are fatally breaking the most important homeostatic functions of an organism.
Diagnosis of abscess of bartoliniyevy gland is carried out by the gynecologist and the laboratory doctor. Establishment of the diagnosis, as a rule, does not cause difficulties and is based on results of the next researches:
- Gynecologic survey. The palpation and survey of vulvar lips allow to find asymmetry of a vulva and painful volume education with inflammation signs: hypostasis, hyperaemia, local temperature increase, fluctuation zones. Increase and morbidity of inguinal lymph nodes also testify to the inflammatory nature of education.
- Laboratory identification of the activator. The cultural analysis separated from a channel is made for the purpose of purpose of optimum antibacterial therapy. As a result of a research opportunistic causative agents of a disease, and also their sensitivity to antibiotics come to light. The PTsR-analysis is carried out for the purpose of identification and adequate treatment of the latent infections. The research allows to find trichomonads, hlamidiya and gonokokk.
In addition appoint clinical blood test, the bacteriological analysis of dab from a vagina. Bartolinov abscess is differentiated with a furuncle (anthrax) of a vulvar lip, tubercular sinter abscess, a purulent cyst of a gartnerov of the course, malignant tumors – cancer and sarcoma of a vulva, cancer of bartolinovy gland. For an exception of malignant new growths at recurrent abscesses at women is more senior than forty years the histologic research of a bioptat of pathological education is conducted. For differential diagnostics can be attracted , , the pathologist.
Treatment of abscess of bartolinovy gland
Bartolinova abscesses treat quickly. The choice of a surgical method depends on a suppuration form (an empiyem or abscess), the nature of process (primary or recidivous), skills of the operating gynecologist, the patient's wishes. At abscess of big vestibular glands it is carried out:
- Wide intsiziya. From a mucous membrane the section of 5-6 cm through which abscess contents are emptied is carried out, the cavity is sanified, in a section the drainage tube is established. Daily washing of a cavity within a week is appointed. Operation can be carried out as in case of true, and false abscess. After broad opening pseudo-abscess can recur.
- Intsiziya with the Word installation of a catheter. Rather new method in domestic gynecology. Through a section of 3-5 mm purulent contents are evacuated and sanitation then Word a catheter – a silicone tube with the inflated ball providing fixing and promoting formation of the channel for outflow of a secret is inserted into an opening is made. The catheter is left for 1,5-2 months. Operation is appointed at single-chamber false abscess, the probability of a recurrence makes about 10%.
- Marsupialization. Through a section of a mucous membrane of a vulva and the capsule of a cyst cleaning and washing of a cavity of abscess then walls of the capsule are hemmed to mucous a vulvar lip for formation of a full-fledged channel is carried out. This method is applied to treatment of multichamber or small false abscesses when the Word installation of a catheter is impossible. The recurrence takes place in 10% of cases.
- Extirpation of bartoliniyevy gland. Through a section from a vaginal mucous membrane completely delete gland together with a channel, then take in its bed. Due to the risk of massive bleeding the hemotransfusion can be required. Operation is shown at recurrent pseudo-abscesses when other methods did not bring satisfactory results: absence of body completely excludes a recurrence.
For the purpose of the prevention of local and generalized purulent complications system empirical antibacterial therapy by medicines of a wide range (ingibitorozashchishchyonny penicillin, macroleads, nitroimidazoles) is appointed, after definition of a type of the causative agent of an infection specific treatment is carried out. Dezintoksikatsionny therapy (intravenous administration of salt solutions) is in case of need appointed.
Forecast and prevention
The forecast is favorable: in the absence of serious complications rational medical actions allow to achieve full treatment of a bartolinov of abscess. In case of use of not radical surgical techniques at a part of patients the education recurrence is possible. The disease will help to prevent timely treatment of urogenital and intestinal infections, a daily careful toilet of a crotch, a healthy lifestyle. Secondary prevention consists in radical treatment of retentsionny cysts of bartolinovy glands.