2-30. EXCISION OF BARTHOLIN DUCT CYST OR ABSCESS
a. General. This procedure consists of removing or incising and draining the
cyst through the vaginal outlet. A cyst in the vulvo- vaginal gland usually follows acute
infection and is treated by marsupialization when it is quiescent. Such cysts are
nonneoplastic and result from retention of glandular secretions due to blockage
somewhere in the duct system.
b. Operative Procedure.
(1) The labia minora are sutured to the perineal skin on each side to expose
the vaginal introitus. Silk or plain gut sutures swaged to 3/8-circle, cutting edge needles
on a needle holder, tissue forceps, and suture scissors are needed.
(2)
An elliptical incision is made in the mucosa, which is distended over the
cyst.
(3) The cyst wall is dissected and blunt-pointed scissors are used for
complete removal of the gland. A drain may be inserted, and a dressing or perineal pad
is applied.
2-31. COLPOTOMY
a. General. Needle culdocentesis is the insertion of an aspirating needle
through the posterior fornix of the vagina. Posterior colpotomy is an incision through the
vagina and peritoneum and the removal of pus and blood. The needle procedure is
done to diagnose ectopic pregnancy or to detect intraperitoneal bleeding or cul-de-sac
hematoma. Posterior colpotomy is done to evacuate pus and establish drainage from a
cul-de-sac abscess or tubo-ovarian abscess, or in a search for blood when a tubal
pregnancy is suspected.
b. Operative Procedure.
(1) For needle culdocentesis, a 15-gauge needle attached to a syringe is
inserted through the posterior fornix of the vagina. Suspected intraperitoneal bleeding
is confirmed if dark or red blood flows freely into the syringe. Failure to obtain blood
does not rule out the possibility of pregnancy completely.
(2) For posterior colpotomy, a transverse incision using angular blade
scissors is made through the vagina and peritoneum behind the cervix at the superior
point of the posterior fornix. The cul-de- sac is punctured with a long Rochester-Pean
hemostat. The jaws of the hemostat are spread apart to enlarge the opening and permit
the flow of liquid from the cul-de-sac. The cavity is explored; drains may be inserted.
MD0928
2-28