Concurrent Bartholin gland and perianal abscesses in a woman: a case report of a diagnostic challenge

BackgroundBartholin gland abscess and perianal abscess are common suppurative infections involving anatomically adjacent regions of the female perineum. Because both conditions may present with localized pain and swelling, distinguishing their respective origins and determining the extent of infection can be challenging. The concomitant occurrence of these two abscesses is uncommon, and its diagnostic and therapeutic considerations remain poorly characterized. We report a rare case of concomitant Bartholin gland and perianal abscesses and describe the diagnostic process and multidisciplinary surgical management.Case presentationAn 18-year-old woman presented with progressive perineal and perianal pain and swelling. Pelvic computed tomography demonstrated abscess formation involving the perianal and left perineal soft tissues, and a possible communication between the two lesions was initially suspected. Emergency surgery was performed. The perianal abscess was incised and drained, and an infected anal gland was identified and excised, with bridge drainage established between the drainage incisions. Intraoperative exploration revealed no communication between the perianal abscess and the adjacent perineal lesion. Following gynecological consultation, the separate left vulvar abscess was drained and treated with Jacobi ring fistulization. Culture of the perineal abscess grew Escherichia coli, whereas the perianal abscess culture showed no bacterial growth. Follow-up magnetic resonance imaging 1 month after surgery demonstrated a cystic lesion in the anatomical region of the left Bartholin gland, supporting the Bartholin gland origin of the previously drained perineal abscess. The patient showed satisfactory clinical recovery, with complete healing of the perianal and perineal wounds at 4 months and no evidence of recurrent abscess during the available follow-up.ConclusionConcomitant Bartholin gland and perianal abscesses may be difficult to distinguish because of their overlapping clinical manifestations and anatomical proximity. Clinicians should consider the possibility of multiple independent or potentially related infectious foci and systematically evaluate adjacent anatomical regions. Careful physical examination, appropriate imaging, intraoperative assessment, and timely multidisciplinary collaboration can facilitate accurate diagnosis and individualized surgical management.