Melike DOĞANAY, Gülçin YILDIRIM, Hatice ÇELİK KANSU, Özlem EVLİYAOĞLU, Burak ELMAS, Esma SARIKAYA

Bartolin Bezi Apselerinin Klinik ve Mikrobiyolojik Özellikleri

Amaç: Bu çalışmada Bartolin apselerinin demografik, klinik özellikleri ve kültür sonuçlarının değerlendirilmesini amaçladıkGereç ve Yöntemler: Çalışmaya Ekim 2013- Mart 2014 tarihleri arasında Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Jinekoloji Polikliniğine başvuran ve bartolin apse tanısı alan hastalar dahil edildi. İşlem esnasında tüm apselerden püy kültürü alındı.Bulgular: Çalışmaya dahil edilen 60 hastanın ortalama yaşı 31,6 19-49 idi. Hastaların 45’i %75 cinsel olarak aktif olduklarını belirtti. Hastaların büyük kısmını 36 hasta,%60 multipar hastalar oluşturdu. Hastaların ortalama C-reaktif protein CRP 21,1 mg/L 2-245 olarak bulundu. Vakaların %65’i 39 hasta ilk defa tedavi alırken, olguların %35’ini nüks vakalar oluşturdu. Apselerin Çoğunluğu %60 sağ labium majusda lokalize idi. Hastaların tamamına cerrahi tedavi uygulandı. Vakalarin 21’inde %35 kültürde üreme saptandı. Ureme saptananlarda en sık etkeni E.coli oluşturdu %21.7 .Tartışma: Bartolin bezi enfeksiyonu düşük-orta sosyo-ekonomik seviyedeki, daha önceden bu bölgede cerrahi girişim öyküsü olan, üreme çağındaki, cinsel aktif bireylerde daha sık görülmektedir. Nüks vakalarda total eksizyon ve marsupiyelizasyon daha çok tercih edilmektedir. Apse kültürlerin %65’inde üreme olmazken, en çok üreyen ajan E.coli %21.7 oldu.

Anahtar Kelimeler:

Bartolin bezi apsesi, marsupiyalizasyon, total eksizyon, gümüş nitrat

Clinical And Microbiological Characteristics of Bartholin’s Gland Abscesses

Aim: The study aimed to evaluate the demographic and clinical characteristics of Bartholin’s gland abscess and culture results.Material And Methods: This study included patients who admitted to Gynecology clinic at Zekai Tahir Burak Women’s Health Training and Research Hospital and diagnosed with Bartholin’s gland abscesses between October 2013- March 2014. During procedure, pus culture was obtained from all abscess.Results: Mean age of 60 patients included in the study was 31,6 19-49 . 45 patients 75% stated that they were sexually active. Multiparous patients accounted for the majority of cases. 36 patients , 60% . Mean C-reactive protein CRP was found to be 21,1 mg/L 2-245 . 65% of cases n=39 were primary abscesses and %35 recurrent abscesses. Majority of abscesses %60 was located in right labium majus. All patients underwent surgical treatment. Pus culture were positive in 21 35% of cases. Escherichia coli was the single most frequent pathogen found 21.7% .Conclusion: Bartholin’s gland infection occurs more frequently in sexually active individuals in reproductive age and at low- middle socio-economic level, who have a previous history of surgical intervention in this region. In recurrent cases, total excision and marsupialization are preferred. While pus culture were negative in %65 of cases, E.coli was the single most common agent in culture-positive abscessses.

Keywords:

Bartholin’s gland abscess, marsupialization, total excision, silver nitrate,

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Zeger W, Holt K. Gynecologic infections. Emerg Med Clin North Am 2003;21:631-48.
Stenchever MA. Comprehensive gynecology. 4th ed. St. Louis: Mosby, 2001:482-6,645-6.
F Omole, BJ Simmons, Y Hacker. Management of Bartholin’s duct cyst and gland abscess. Am Fam Physician. 2003;68:135-40.
Wechter ME, Wu JM, Marzona D, Hoefner H. Management of Bartholin duct cysts and abscess. A systematic review. Obstet Gynecol Surv 2009;64:395-404.
Berger MB, Betschart C, Khandwala N, DeLancey JO, Haefner HK. İncidental bartholun gland cysts identified on pelvic magnetic resonance imaging. Obstetrics and Gynecology. 2012;120:798.
Kessous R, Aricha-Tamir B, Sheizaf B, Shteiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological characteristics of Bartholin gland abscesses. Obstetrics & Gynecology. 2013;122:794-9.
Omole F, B.J. Simmons, and Y.Hacker. Management of Bartholin’s duct cyst and gland abscess. Am.Fam.Physician 2003;68:135-140.
Timur H, Ozcan KN, Tokmak A, Inal HA, Sarikaya E, Uygur D. Pregnancy and Bartholin abscess: examination of 47 cases. J Gynecol & Obstet and Neonatol.
Tanaka K,Mikano H, Ninomiya M, Tamaya T, Ito K ,et al. Microbiology of Bartholin abscess in Japan. J Clin Microbiol 2005;43:4258-61.
Saeed NK, Al-Jufairi ZA. Bartholin’s gland abscess caused by streptococcus pnomonia in primigravida. Journal of Laboratory Physicians, June-Dec 2013/vol-5/Issue-2.
Pinsky BA. , Baron EJ, Janda M, Banaei N. Bartholin’s abscess caused by hypermucoviscous Klebsiella pnomonia. Journal of Medical Microbiology 2009;58:671-73.
Hill D.A, J.J. Lense. Office management of Bartholin gland cysts and abscess.Am.Fam.Physician 1988;57:1611-1616;1619-20.
Lopez-Zena, J.A. ,E.Ross, and J.P. O’Grandy. Septic shock complicating drainage of a Bartholin gland abscess. Obstet Gynecol 1990;76:915-16.
Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv. 2009;64:395-404.
Ergeneli MH. Silver nitrate for Bartholin gland cysts. Eur J Obstet Gynecol Reprod Biol. 1999;82:231-2.
Kafali H, Yurtseven S, Ozardali I. Aspiration and alcohol sclerotherapy: a novel method for management of Bartholin’s cyst or abscess. Eur J Obstet Gynecol Reprod Biol. 2004; 15:112:98-101.
Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol. 2008;15:327-31.
Di Donato V, Bellati F, Casorelli A, Giorgini M, Perniola G, Marchetti C, Palaia I, Benedetti Panici P. CO2 laser treatment for Bartholin gland abscess: ultrasound evaluation of risk recurrence. J Minim Invasive Gynecol. 2013;20:346-52
Andersen PG, Christensen S, Detlefsen GU, Kern-Hansen P. Treatment of Bartholin’s abscess. Marsupialization versus incision, curettage and suture under antibiotic cover. A randomized study with 6 months’ follow- up. Acta Obstet Gynecol Scand. 1992;71:59-62.
Mungan T, Uğur M, Yalçin H, Alan S, Sayilgan A. Treatment of Bartholin’s cyst and abscess: excision versus silver nitrate insertion. Eur J Obstet Gynecol Reprod Biol. 1995;63:61-3.
Rouzier R, Azarian M, Plantier F, Constancis E, Haddad B, Paniel BJ. Unusual presentation of Bartholin’s gland duct cysts: anterior expansions. BJOG. 2005;112:1150-2.
Ozdegirmenci O, Kayıkcioglu F, Haberal A. Prostective randomized study of marsupialization versus silver nitrate application in the management of bartholin gland cysts and abscesses. J Minim İnvasive Gynecol. 2009;16:149-52.