REFLEKSI KASUS

KISTA BARTOLINI
Charles Ferdinand
406152095
RSUD RAA Soewondo Pati - UNTAR
IDENTITAS PASIEN
Nama : Ny. P
Usia : 37 th
Alamat : diketahui
Jenis Kelamin : Perempuan
Pendidikan : SD
Pekerjaan : IRT
Status pernikahan : menikah (10 tahun)
Agama : Islam
Anamnesa (27/12/12)
Keluhan Utama :
Perempuan 37 th datang ke RSUD RAA Suwondo melalui
rujukan puskesmas, keluhan ketuban pecah pukul 23.00
(26/12/12).
Riwayat benjolan pada bagian kemaluan sebelah kanan
bawah sejak 1 bl SMRS. Nyeri (-)
 Anamnesa
Keluhan Tambahan : tidak nyaman pada
daerah kemaluan (mengganjal)
saat bergerak
Riwayat obstetri :P3A0
Riwayat penyakit dahulu
HT (-), DM (-), Asma (-), Jantung (-)
Riwayat Penyakit keluarga
HT (-), DM (-), Asma (-), Jantung (-)
Riwayat konsumsi obat : (-)
Alergi : (-)
Anamnesa
Riwayat KB : pil
Riwayat Operasi :-
Riwayat pijat/jamu : -/-
Pemeriksaan Fisik
Keadaan Umum : Tampak sakit ringan
Kesadaran : CM
Tanda vital
TD : 120/70 mmhg
Suhu : 36,6C
Nadi : 80 x/menit
RR : 18 x/menit
BB : 64 kg
 Pemeriksaan Fisik
Mata : CA-/-, SI -/-
Toraks
Jantung : BJ 1& 2 reg, murmur(-), gallop(-)
Paru : Vesikuler +/+
Abdomen
Inspeksi :Datar, striae (+)
Palpasi :Supel, kontaksi uterus 2 jari dibawah umbilikus
Perkusi : Timpani
Auskultasi : Bising usus + normal
Genitalia eksterna
Inspeksi : tampak bekas jahitan pada bagian kanan bawah
labia mayora
Pemeriksaan penunjang
Pemeriksaan Nilai Nilai normal
Hematologi
Leukosit 12,8 5,0-14,5 103/uL
Eritrosit 4,13 4,2 5,4 106/uL
HGB 12,7 11,7 15,5 g/dL
Ht 34,8 35 45 %
Trombosit 338 181 521 103/uL
MCV 82,5 72 88 fL
MCH 28,9 23 34 pg
MCHC 35 32 36 g/dL
GDS 92 70-125

SGOT 46,4 0-31

SGPT 58,5 0-31

Diagnosa
P3A0, post marsupialisasi a/i kista bartolin
Tata laksana
Amox 500 mg / 8jam
Asmef 500 mg / 8 jam
Meth 0,125 / 8 jam
Marsupialiasasi
PEMBAHASAN
Abses & kista Bartolin
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Introduction
Commonest gyn cystic disease of the vulva (labia majora)
2% of women, reproductive age
Abscesses 3x > cysts
Oval, size of 0.5 - 1 cm, 2 - 2.5 cm in length, 0.5
Positions 4 and 8 oclock between the labia minora and
hymenal edge into the vestibule. Lateral to
bulbocavernosus muscle
Function lubricates vagina & vulva (sexual intercourse)
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Introduction
Obstruction of the Bartholins duct retention of
secretions dilatation of the duct and cyst formation
may become infected abscess
Etiology
Infection (sexualy transmitted Infection)
Thick Mucus
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Risk Factor
History of Bartholins gland cyst,
Multiple sexual partners,
Sexually transmitted infection,
Medio-lateral episiotomies,
Vulva trauma
Diagnosis
Anamnesis
Physical Examination
located in the labia,
the surrounding skin must remain undamaged,
at least a small amount of glandular epithelium present
Gold Hystological examination
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Patophysiology
Obstruction of duct infection, trauma changes in
mucus consistency or congenitally narrowed duct distal
ducts are blocked mucus build-up with continued
secretion cystic dilation of the duct leading to cyst
formation Infection of this cyst is likely to result in
Bartholins gland abscess

Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Clinical Manifestation
Asymptomatic pelvic examination
Enlarged discomfort walking and sexual intercourse.
Infection of the cyst abscess formation (severe pain,
dyspareunia, fever and limitation of physical activity)
Usually unilateral
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Supporting Examination
Discharge from the gland Culture & sensitivity.
Absence swabs are taken from endo-cervix, rectum,
vagina and urethra for microbial culture and sensitivity
Bacteroides spp. and Escherichia coli predorminate
Biopsy and histology is recommended in women > 40
years (possible malignancy)
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Management
Smaller cysts (asymptomatic) left untreated
Symptomatic cysts or abscesses conservative (warm
sitz baths, compresses, analgesics and antibiotics)
Incision
Drainage
Marlsupialization
Post-operatively, antibiotics chemotherapy drug (should
be broad spectrum).
Incision
Drainage
 Marsupialisation
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Complication
Recurrence
Severe pain
Dyspareunia
Difficulty in walking
Psychological trauma due to stigmatization
Marital disharmony
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Study
21 cases 18 patients (85.7%) presented with
Bartholins gland cyst or abscess out of the 1015
gynaecological surgeries (Federal Teaching Hospital
Abakaliki)
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305
Incidence,Presentation, & Management of Bartholins Gland Cysts/Abscesses, 2016, 6, 299-305

Conclusion
Most common
Study 1015 gyn surgical cases 18 for Bartholins
gland cysts or abscess (incidence of 1.78%)
Reproductive age
Risk factor previous history of the disease in 14
(77.8%) followed by previous history of STD 8 (44.4%).
Pain commonest presenting symptom in 14 (77.8%)
E. coli 16 (88.9%) & S. aureus 14 (77.8%).