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Abstract: Patient Ms. Wang, 58 years old, presented to the clinic with fever and vulvar enlargement with severe pain, which even affected the patient’s normal walking. After understanding that the patient had a previous history of vestibular gland enlargement, physical examination revealed that her vulva was significantly swollen and could be palpated with fluctuating sensation. She was considered to have a vestibular gland cyst and was given an ultrasound examination of the vulva to clarify the diagnosis. According to the patient’s symptoms and medical history, surgery and medication were given, and the patient was eventually cured.
Basic information】Female, 58 years old
Type of disease】Vestibular gland cyst
Hospital】Shengjing Hospital of China Medical University
Date of Consultation】September 2020
Treatment plan】Surgery (vestibular gland dissection surgery) + intravenous infusion (cefuroxime sodium for injection)
Treatment period】1 week of hospitalization
Treatment effect】Cured
I. Initial consultation
A 58-year-old female patient came to the clinic and reported that she had experienced enlargement of the vestibular gland many years ago, resulting in enlarged, red and swollen vulva and more obvious pain.
However, 1 week ago, the patient’s vulva became swollen again without any painful symptoms, so she thought it was the same as before, so she still did not pay attention to it. Today, the patient suddenly had a fever and the enlargement of vulva worsened, accompanied by severe pain, which even affected the patient’s normal walking. In order to clarify the cause and seek treatment, the patient came to our hospital.
We found that the patient had more vaginal discharge and vaginitis from time to time, which could be improved with medication. After examination, the patient was found to have a swollen vulva with palpable fluctuating sensation, and was considered to have a vestibular gland cyst.
II. Treatment process
After admission, the patient was given an ultrasound of the vulva, which showed a mixed echogenic mass in the vulva, and the diagnosis of vestibular gland cyst could be clarified. After the diagnosis was confirmed, the patient was given various preoperative preparations, including routine blood tests, coagulation, immune factors, electrocardiogram, chest X-ray, negative ultrasound and other relevant tests to exclude contraindications to surgery.
The patient was informed that because of his long condition and frequent recurrence, in order to reduce the chance of recurrence, it was recommended to choose vestibular gland stripping surgery, but since this surgery is a complete stripping of the affected vestibular gland, the patient may have symptoms of vaginal dryness and atrophy after the surgery, and the patient expressed his understanding and agreed to undergo the surgery. Cefuroxime sodium for injection was given as anti-infective treatment before the operation, and the vestibular gland dissection was performed under local anesthesia. The operation was relatively smooth, with little intraoperative bleeding. After the patient returned to the ward, anti-infection with cefuroxime sodium for injection was continued.
III. Treatment effect
The patient’s vestibular gland dissection surgery went smoothly, and there were transient fever symptoms after surgery, but the fever symptoms disappeared after intravenous cefuroxime sodium for injection, and the patient’s surgical incision did not show bleeding or hematoma, and the vulvar swelling subsided significantly.
After 1 week of hospitalization, the results of the reexamination of the blood picture returned no abnormalities, the antibiotics were discontinued, and the patient was discharged cured. One month after discharge, the patient came again for review and reported that her pain symptoms disappeared and she could walk normally, and her postoperative complications were small and did not affect her normal life, and no mixed echogenic masses were seen on ultrasound of the vulva given for review, indicating that the vestibular gland cyst was completely removed and the treatment effect was good.
IV. Notes
We are glad that after active treatment, the patient’s vestibular gland cyst was completely excised and the treatment effect is better. However, since the disease has a certain chance of recurrence, patients should also pay attention to the following points in their daily lives.
1, in life, patients should pay attention to vulvar hygiene, diligently change underwear, keep dry, and diligently change sanitary napkins during menstruation. In terms of dress, try to choose breathable, cotton underwear and avoid wearing non-breathable, too-tight jeans. In addition, to maintain good sleep habits, avoid staying up late, so as not to reduce the body’s immunity, which can easily lead to various diseases.
2. In terms of diet, take a light diet, eat more fresh vegetables and fruits rich in vitamins and water, and drink more water, but avoid eating spicy and stimulating foods, such as chili, hotpot and spicy hotpot.
V. Personal insight
Vestibular gland cysts are caused by blockage of the gland, resulting in the inability to remove the glandular fluid and the formation of separated cysts or abscesses after retention of the glandular fluid. Patients mostly present with hard, red and swollen vulva and significant pain. Early intervention for vestibular gland cysts is effective, and the treatment often varies depending on the patient’s specific symptoms and the size of the cyst, including medication and surgery. In this case, due to the long duration of the disease, conservative treatment was less effective, so after completing various tests, the patient was given vestibular gland dissection surgery, and the disease was eventually cured. This shows that when physical discomfort exists, timely consultation and early treatment should be sought to avoid delaying the disease.