investigations

Last reviewed 01/2018

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