Investigations

Investigations for Fourniere's Gangrene include:

• blood tests:
  • random glucose - for occult diabetes mellitus
  • urea and electrolytes; to investigate dehydration
  • full blood count:
    • to provide additional evidence for infection if there is leukocytosis and gives a coarse index of the severity
    • platelets; thrombocytopaenia can be triggered by sepsis
  • clotting; may be abnormal in sepsis
  • blood cultures; if pyrexial
• plain X-ray films; not particularly helpful but may show gas in the soft tissues or a foreign body
• MRI and CT;
  • can indicate the extent of soft tissue swelling and/or gas in tissue planes
  • however, due to the time entailed by these imaging modalities, they are not indicated in the presence of a septic patient in whom the clinical picture strongly suggests Fourniere's Gangrene - debridement in theatre is mandated
• biopsy of the fascia for diagnosis:
  • can be done at the bedside in a relatively well patient by incisional biopsy over an area of maximal fluctuance or tenderness
  • however, in the unwell patient a full debridement of clearly necrotic tissue and sending of samples taken with clean instruments is mandated
  • samples are sent for urgent microbiology and histology:
    • urgent gram stain can guide empirical initial antibiotics
    • histology can reveal the characteristic picture of:
      • fibrinoid necrosis of nutrient perforating arterioles to the skin
      • necrosis of superficial and deep fascia
    • neutrophil infiltrate
    • micro-organisms associated with the necrotic tissue