Gardner's duct cyst is a remnant of the distal end of the mesonephric duct in females. We describe a case of a large Gardner's duct cyst and its operative management. The patient is a 44-year-old para 4 who presented with feeling a bulge in the vaginal area for 5 years. This had been progressively getting uncomfortable and interfering with her sexual activity. On exam, there was a 13 cm cyst protruding from the right aspect of the vagina, extending past the hymen. It measured 5 cm transversely. A CT scan showed a cystic structure measuring 18 by 4 cm along the right side of the vagina with increased attenuation. The ipsilateral kidney and ureter were normal, as was the uterus, except for multiple fibroids. This was consistent with a Gardner's duct cyst. Patient underwent surgical excision of the cyst. After prepping and draping, an exam under anesthesia confirmed a Gardner's duct cyst extending to the right retropubic region to the apex of the vagina. Patient underwent a total abdominal hysterectomy for fibroid uterus concurrently. After the bladder had been carefully dissected down from the vagina, attention was turned to the vaginal portion of the case. Dilute vasopressin was injected circumferentially. A transverse incision was made around the cyst, carefully avoiding rupture of the cyst. In these cases, the cyst is located mainly between the vagina and the cervix and consists of mucous-producing cells. Usually, there is no continuity with the vagina or the uterus, making it a closed cystic structure. In most cases, the cyst is asymptomatic, less than 2 cm in size, and is accidentally found during routine gynecological examination. However, over time and due to mucous production, the cyst may enlarge and become symptomatic and interfere with sexual activity. There has been one case report of a large Gardner's duct cyst measuring 8 cm, which was managed by drainage and marsupialization of the cyst. Rare cases of adenocarcinoma and clear cell carcinoma have been described to occur in these cysts. A description of this case is very interesting because in addition to the rarity of being a very large Gardner's duct cyst of approximately 18 cm, the kind of surgical approach in these cases is controversial. The posterior vaginal wall is dissected free from the cyst sharply using tenotomy scissors. This anomaly may be associated with other developmental anomalies involving the mesonephric duct, such as an ectopic ureter, communication with the vagina, and ipsilateral renal agenesis. Common associated uterine anomalies include uterine didelphys and bicornoid uterus. Operative excision is indicated for chronic symptoms. If the cyst is small and asymptomatic, observation is usually sufficient. Rarely one of these cysts becomes infected, and if operated on during the acute phase, marsupialization of the cyst is preferred. The cystic structure may extend up into the broad ligament and anatomically be in proximity to the distal course of the ureter. After dissecting the posterior wall free from the cyst, attention was turned to the anterior vaginal wall, which was then dissected free from the cyst with sharp dissection using tenotomy scissors, as well as the bovine. Vaginal cysts are reported in about 1 in 200 women. However, the true frequency is underestimated because most cysts are not reported. Differential diagnoses for vaginal cysts include Bartholin's gland cyst, pneumothorax cyst, epidermal inclusion cyst, endometroid cyst, cervical polyp, pelvic organ prolapse, urethral diverticulum, unilateral hematoclposis, leiomyoma of the vaginal wall, ectopic ureter, obstructed aberrant ureter, and unclassified cyst. Most of these benign cysts are asymptomatic that are discovered only incidentally during pelvic examination. The cysts may be differentiated histologically by the epithelial lining. Occasionally, pressure produced by the vaginal wall may cause the cyst to be dilated. This may be due to the presence of a large amount of fluid in the vaginal wall, which may cause the cyst to dilate. The cysts may be differentiated histologically by the epithelial lining. Occasionally, pressure produced by the cystic fluid produces flattening of the epithelium, which makes histologic diagnosis less reliable. Gardner's duct cysts are lined by cuboidal epithelium. The cyst is then freed from the apical portion, again, using sharp dissection. It is removed intact. The dead space is sutured with 2-ovicryl in layers. The excess vaginal tissue is trimmed. The excess vaginal tissue is trimmed. The excess vaginal tissue is trimmed. The excess vaginal tissue is trimmed and re-approximated using 2-ovicryl. A cystoscopy is performed at the end of the procedure and confirmed bilateral ureter reflux and normal bladder mucosa and urethra. Pathology confirmed a Gardner's duct cyst, and this was shown by the pathology slides showing cuboidal epithelial lining. The patient followed up in 6 weeks and had a well-healed vaginal mucosa.

Gardner's duct cyst

large cyst

vaginal bulge

surgical excision

total abdominal hysterectomy