CASE REPORT SESSION

BARTHOLIN CYST

Supervised by:
dr. Ismu Setyo Djatmiko, Sp.OG

Presented by:
Ray Praditya Putra Sugraha
2013730090

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

RSUD R. SYAMSUDIN, S.H., KOTA SUKABUMI
MEDICAL FACULTY OF MUHAMMADIYAH JAKARTA UNIVERSITY
2017
 CHAPTER I
INTRODUCTION

Bartholin's gland cyst is a fluid-filled swelling of a Bartholin's gland. Bartholin's glands

are two small glands on each side of the opening of the vagina at about the 4 and 8 o’clock
positions. They have small ducts that open to the outside. The glands produce a fluid that helps
protect the tissues around the vagina and provides lubrication during sexual intercourse.
Normally, these glands cannot be felt or seen.

Bartholin’s gland cyst is common problems in women of reproductive age. Two percent
of women develop a Bartholin’s duct cyst at sometime in life. They are exceedingly rare before
puberty .

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 CHAPTER II
CASE

2.1 Identity

Patient’s Identitiy
 Name : Mrs. A
 Date of Birth/Age : 34 years old
 Nationality : Indonesian
 Ethnic : Sundanese
 Address : Kp. Karang Gantung RT 26/05
 Graduate from : Elementary School
 Marital status : Married
 Occupation : Housewife
 Religion : Moslem
 Date of admission : September 13th 2017
 Date of examination : September 13th 2017

Husband’s Identity
 Name : Mr. M
 Date of Birth/Age : 45 years old
 Nationality : Indonesian
 Ethnic : Sundanese
 Address : Kp. Karang Gantung RT 26/05
 Graduate from : Elementary School
 Marital status : Married
 Occupation : Driver
 Religion : Moslem

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2.2 HISTORY TAKING

Chief Complaint
The patient complained of lumps on the genitalia since 8 months ago.
History Of Present Illness
The patient came to RS Syamsudin at 10:30 with complained of lumps in the
genitalia since 8 months ago, the lump getting bigger and feels as big as quail egg. The
patient feel pain when suppressed and itching. The patient denied the pain during
walking, sitting, or coitus. There is no interference from micturition and defecation. The
patient admitted to frequent whitish smells and itching.

History Of Past Illnesses

 No history of chronic diseases
 No history of allergy
 No history of genitalia disease before
 History of asthma

Family History
• Patient denied had a same complain with other family.

Menstruation History
• Menarche : Never getting menstruation since puberty
• Cycle :-
• Duration :-

Marriage History
Patient said she had been married 1 time when she was 19 years old and now has been 15
years.

Contraception History
She was not using contraceptive.

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 Gestational History
She was never pregnancy as long she was married.
2.3 PHYSICAL EXAMINATION
• General Condition : moderate ill
• Alert : compos mentis
• Blood Pressure : 130/80 mmHg
• Heart Rate : 8o ×/ minuts
• Respiratory Rate : 20x/minutes
• Temperature : 36,5 0 C
• Body weight : 59 kg
• Height : 157 cm
• BMI : 23,9 kg/m2

General Examination
 Eye : Conjunctiva anemic : -/-, Icterric Sclera -/-
 Mouth : Wet oral mucosa membrane
 Heart : Regular 1st and 2nd heart sound, murmur -, gallop -
 Lung
- Inspection : symmetric chest expansion in breathing
- Percussion : resonant on both lungs
- Auscultation : vesicular breath sounds +, ronchii -/-, wheezing -/-

 Abdomen
- Inspection : convex
- Palpation : Palpable abdominal mass, tenderness (-)
- Auscultation : bowel sound (+)
- Shifting dullness : Negative
- Defense Muscular : Negative
 Extremities : edema -/-/-/-, CRT < 2 seconds

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 Gynecology Examination
Inspection
 Fluxus ( negative )
 Looking lumps of quail egg on the right labia minora with size 3 cm x 2 cm
Inspeculo examination
 Are not done
Vaginal toucher
 Vulva : Palpable lumps in the right labia minora of quail egg with a supple
consistency and tenderness
 Vagina : Within normal limit
 Portio : Size and Consistency normal
 Corpus uteri : Size and shape normal
 Adnexa : Within normal limit
 Douglas pouch : Within normal limit

2.4 LABORATORY EXAMINATION

• Hemoglobin : 13.1 g/dL
• Leukosit : 8.000 /µL
• Hematokrit : 38%
• Trombosit : 4.3 million/µL

2.5 WORKING DIAGNOSE

Mrs. A, 34 years old, P0A0, with Bartholin cyst dextra and Primary Amenorrhea

2.6 MANAGEMENT
 Bartholin cyst » Pro Extirpation
 Primary Amenorrhea » Referr to Hasan Sadikin Hospital (RSHS)
(polyclinic of endocrinologist)

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2.7 FOLLOW-UP

September 13th 2017

S : The patient says of lumps on the genitalia with suppressed pain and she also never
getting menstruation since puberty.
O:
• General Condition : moderate ill
• Alert : compos mentis
• Blood Pressure : 130/80 mmHg
• Heart Rate : 8o ×/ minuts
• Respiratory Rate : 20x/minutes
• Temperature : 36,5 0 C
Physical examination : Palpable lumps in the right labia minora of quail egg with a
supple consistency and tenderness.
A : Mrs. A, 34 years old, P0A0, with Bartholin cyst dextra and Primary Amenorrhea
P : - Extirpation of Bartholin cyst
- Vital sign observation
- IVFD RL 500 cc
- Referr to Hasan Sadikin Hospital (RSHS) for primary amenorrhea
(polyclinic of endocrinologist)

The patient brought to VK for do the extirpation on September 14th 2017

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 The patient has been operation on September 14th 2017 morning at 08.00 am for 45
minute.

Post Operation
September 14th 2017
S : The patient felt pain in wound surgery
O:
• General Condition : moderate ill
• Alert : compos mentis
• Blood Pressure : 120/80 mmHg
• Heart Rate : 81 ×/ minuts
• Respiratory Rate : 20x/minutes
• Temperature : 36,5 0 C
A : Mrs. A, 34 years old, P0A0, Post Extirpation as indication Bartholin cyst dextra
P : - Vital sign observation and bleeding sign
- Cefadroxil 2x500 mg
- Metronidazole 3x500 mg
- Mefenamic acid 3x500 mg
- Referr to Hasan Sadikin Hospital (RSHS) for primary amenorrhea
(polyclinic of endocrinologist)

2.8 FINAL DIAGNOSE

Mrs. A, 34 years old, P0A0, Post Extirpation as indication Bartholin cyst dextra and
primary amenorrhea.

2.9 PROGNOSIS

 Quo ad vitam : ad bonam

 Quo ad functionam : ad bonam
 Quo ad sanationam : ad bonam

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 CHAPTER III

CASE ANALYSIS

Problems:
1. How to diagnosed this patient ?
2. What are the complications?
3. What are the management of this patient?

Discussion :

1. How to diagnosed this patient?

Diagnosed of the Bartholin cyst:
a. Anamnesis
b. Physical Examination

Diagnosed

THEORY CASE

ANAMNESIS  Symptomatic:  Symptomatic:

 Bartholin's cyst usually only
affects the gland
on one side
 Bartholin's cyst usually
getting bigger
 Lumps on the right labia minora
(dextra)
 The lump getting bigger and
feels as big as quail egg

PHYSICAL  Swelling – a round, painless  Palpable lumps in the right

EXAMINATION or slightly tender bulge near labia minora
the opening of the vagina.

 Tenderness/pain – especially  Tenderness

if the cyst is infected, walking
or sitting may be painful.

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2. What are the complications ?

As with any procedure there may be complications. The risk of

complications during treatment of a Bartholin’s cyst or abscess is very small. The
risks to be aware of for the Bartholin Gland Balloon (Word Catheter) and
Marsupialisation include:
 Discomfort at the site where the small cut is made (and where stitches are placed
in the case of Marsupialisation).
 Infection – increasing redness, inflammation or pain around the area or feeling
feverish and unwell. You will be given antibiotics to help treat the abscess which
greatly reduces the risk of further infection.
 Bleeding – from the small cut made in the skin
 Bruising – around the abscess
 Recurrence of the cyst or abscess

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 3. What are the management of this patient?

THEORY CASE

MANAGEMENT  Word Catheter  Extirpation (Masrupialization)

A word catheter is commonly
used to treat bartholin’s duct
cyst and gland abscesses. The
stem of this rubber catheter is
1 inch long and the diameter
of a no. 10 french foley
catheter. The small, inflatable
balloon tip of the word
catheter can hold about 3 ml
of saline. Performed under
local anesthetic.
 Masrupialization
An alternative to word
catheter placement is
marsupialization of a
Bartholin’s cyst. This
procedure should not be used
when an abscess is present.
Performed a procedure under
local anesthetic.
 Excision
Excision of the Bartholin’s
gland should be considered in
patients who do not respond
to conservative attempts to
create a drainage tract, but the
procedure should be
performed when there is no
active infection.

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 Reference

1. Hoffman, BF, Schorge JO, dkk. 2013. Williams Gynecology ed 2. New York: MC Graw
Hill
2. Omole F, Simmons, Hacker Y. Management of Bartholin’s Duct Cyst and Gland
Abscess. American Family Physician. 2011;68:135-40
3. Berek and Novak's Gynecology 15th Edition Lippincott Williams and Wilkins, 2012.

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