Perianal fistula (grade 4): transsphincteric
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A 6 o'clock transsphincteric perianal fistula is seen piercing both layers of the sphincter complex and takes a downward course through the ischiorectal and ischioanal fossae before reaching the perineal skin. Small abscess is seen in the tract, making it grade 4 (St James’s University Hospital Classification).
Two working classifications of perianal fistulae: St James’s University Hospital Classification and Parks classification
- MR Imaging Evaluation of Perianal Fistulas: Spectrum of Imaging Features ,RadioGraphics 2012; 32:175–194