Progressive synergistic bacterial gangrene arising from abscesses of the vulva and Bartholin's gland duct

Abstract

Six cases of diabetes mellitus, diabetic ketoacidosis, and progressive synergistic bacterial gangrene arising in Bartholin's gland duct abscesses and vulvar abscesses are presented. Four of the cases were managed in a conservative fashion with antibiotic therapy and incision and drainage. Three patients died, and one patient is totally disabled as a result of the disease. Two cases were managed with wide excision of the necrotic and infected tissues. These patients had good end results. Brewer and Meleney2 reported 2 cases of progressive synergistic bacterial gangrene of the skin and subcutaneous tissues following appendectomy. They demonstrated that successful treatment requires wide excision beyond the extent of induration and necrosis. The cases reported in this article demonstrate that patients with diabetes mellitus and an abscess of Bartholin's duct or of the vulvamust be considered to have a necrotizing fascitis secondary to a synergistic infection until proved otherwise. Such patients should have the vulva explored under anesthesia as soon as the ketoacidosis has been corrected, and, if necrosis is found radical excision to include removal of all necrotic and indurated tissues should be performed.