CASE PRESENTATION ON BILATERAL BARTHOLIN CYST

1. CASE PRESENTATION
ON
BILATERAL BARTHOLIN CYST
Presented by
DEEPAK KUMAR
PHARM.D

2. Patient demographics
• Name - xyz
• Age - 24 years
• Gender - Female
• Unit - OBG
• DOA - 1/2/22
• DOD - 3/2/22

3. Complaints on admission
• Swelling in vulvar region associated with pain since 5
months.

4. Physical examination:-
• BP – 110/70 mmhg
• Pulse – 88 bpm
• Temp – 98°F
• RR – 19 cpm

5. History of present illness
• Asymptomatic 5 months ago and the she developed swelling in left and right
labial region which was insidious in onset, small in size.
• It gradually progressed to present size ( left labia 3x3 cm, right labia 2.5x2 cm)
• It associated with pain and she used medications (unknown) for 5 days.
• After using that medication, the condition got better but again recurred.
• Marital life – 6 months
• LMP – 9/7/2021
• UPT – POSITIVE
• GA – 20 weeks on iron and calcium supplements.

6. Physical examination
• O/E – masses were noted on left and right labia.
• Pallor +

7. Lab investigations
• HB - 8.4g/dl
• WBC – 11,400/cumm
• USG – well defined masses on inner side of both labia.
Right labia - 2.9 x 2.2 cm
Left labia - 3.3 x 2.5 cm

8. Provisional diagnosis
• Bilateral bartholin cyst

9. SOAP NOTES
FOR
BILATERAL BARTHOLIN CYST

10. Subjective evidence
• Swelling in vulvar region associated with pain.

11. Objective evidence
• USG – Well defined masses on inner side of both labia.
Right labia - 2.9 x 2.2 cm
Left labia - 3.3 x 2.5 cm
O/E – masses were noted on left and right labia.

12. Assessment
From subjective and objective evidence patient is diagnosed
with BILATERAL BARTHOLIN CYST

13. Therapeutic goals
Patient specific:
To reduce swelling associated with pain.
Disease specific:
To reduce further complications like septic shock, cellulites, and
dyspareunia.

14. CURRENT MEDICATION
Drugs Dose Route Freq Day-1
(29)
2
(30)
3
(1)
4
(2)
5
(3)
Inj. Cefotaxim 1gm IV BID + + + - -
Inj. Metronidazole 100ml IV BID + + + - -
Tab. Vitamin – C 500mg PO OD + + + + +
Inj. Pantoprazole 40 mg IV OD + + + - -
Tab. Calcium 1000mg PO OD + + + + +
Tab. Multivitamin 1 tab PO OD + + + + +
IVF RL @ 75ml/hr - + - - -

15. CURRENT MEDICATION
Drugs Dose Route Freq Day – 1 2 3 4 5
Diclofenac suppository PV SOS - + + + -
Tab. Cefixime 200mg PO BD - - - + +
Tab. Metronidazole 400mg PO TID - - - + +
Tab. Pantoprazole 40mg PO OD - - - + +
Inj. Ferrous surcose 200mg in
100ml NS
IV OD - - + - +
Sitz bath with betadine - - TID - - + + +
Oint. Metronidazole - L/A - - - + + +

16. Day progress chart
Days Clinical notes
1 Planning for incision and draining.
2 Drained cyst fluid and marsuplisation done.
10ml pus in left side and 5ml pus in right side.
Sent for culture test.
3 No fresh complaints
4 No fresh complaints
5 No fresh complaints
Plan for discharge

17. Discharge medications
DRUGS DOSE ROUTE FREQUENCY COMMENTS
T . CEFIXIME 200MG PO BD 2 DAYS
T .
PANTROPRAZOL
E
40MG PO OD 2 DAYS
T . VITAMIN – C 500MG PO OD 15 DAYS
T . CALICIUM 1000MG PO OD 15 DAYS
T . MULIT
VITAMIN
1 TAB PO OD 15 DAYS
T . FERROUS
ASCORBATE
100MG PO BD FROM DAY – 3 (
FOR 15 DAYS )
METRONIDAZOL
E OINTMENT
- L/A - 15 DAYS
SITZ BATH WITH
BETADINE
- L/A TID 15 DAYS

18. Interactions
• Pantoprazole + Ferrous Ascorbate = Decreased iron
absorption.
• Calcium + Ferrous Ascorbate = Decreased iron absorption.

19. Monitoring parameters
• HB levels

20. Patient counselling
Disease specific
Bartholin cyst is a condition in which bartholin gland is blocked
and forms cyst. Bartholin cyst may occur between 20-30years
women. Size of the cyst varies with time.
It is a common condition, almost 3% of women suffer with
bartholin cyst.

21. Drug specific
• Take medication regularly as prescribed by your physician
• Take pantoprazole tablet on empty stomach in the morning
• Take cefixime tablet after food in the morning and night
• Take vitamin – c tablet 30mins before taking ferrous ascorbate for
better absorption of iron.
• Take multivitamin tablet daily once at afternoon
• Take calcium tablet daily once after food in the afternoon
• Apply metronidazole ointment a thin layer to vagina usually at
night time.
• Consult your physician before adding or removing any medication

22. Life style modifications
• Drink plenty of water
• Use cotton under wears
• Keep area around vagina hygiene
• Do not hold urine for long time
• Do not burst the cyst with needle or any sharp objects
• Drink turmeric water with pepper, it helps to relief symptoms
• If cyst is oozing wear a pad to avoid staining
• Take vitamin - C foods like lemons, oranges and tomatoes
• Take probiotic foods like yogurt, curd to maintain normal vaginal microflora
• Avoid vigorous exercises
• Consult your doctor about sexual health.

23. • Use sitz bath – take a tub is easy to sit in and fill it with lukewarm water upto
3/4th. Pour some betadine in to the water and mix it well. Sit in the tub for at
least 15 minutes. Sitz bath helps in the rupture of cysts thet helps too drain
the cyst.

24. MARSUPIALIZATION

26. BARTHOLIN CYST

27. THANK YOU