St James · Cólon

St James University Hospital classification of perianal fistula

vigente

Grades perianal fistulas on MRI by anatomy and complications.

Índice de referência, não é suporte à decisão clínica. O RadCommons apresenta conteúdo de referência reescrito a partir de critérios publicados e com link para a fonte primária. Confira sempre a publicação primária vigente. Não é um dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Escala de categorias

1 2 3 4 5

As figuras e tabelas estão na fonte primária. Abrir a fonte. O RadCommons reescreve e cita, não reproduz figuras protegidas por direitos autorais.

Procedência e vigência

Órgão emissor: Radiology consensus
Versão: 2000
Ano: 2000
Família: léxico
Tipo de lógica: flat
Modalidade: MRI
Fonte primária: MR imaging classification of perianal fistulas (St James University Hospital)
Última verificação: 2026-06-26
Última checagem: 2026-06-26

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    "1",
    "2",
    "3",
    "4",
    "5"
  ]
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
1	Grade 1 Simple linear intersphincteric fistula (single tract penetrating the internal sphincter to run between internal and external sphincters and exit the perineum, with no secondary extension or abscess).	Counts as a 'simple'/low fistula: generally amenable to laying-open (fistulotomy/fistulectomy) with low risk of incontinence, since no external-sphincter muscle is divided.	Favorable: grades 1-2 were associated with a satisfactory outcome, versus grades 3-5 (unsatisfactory, e.g. need for further surgery; P<0.001) in the cited series.	okfonte Criteria/management/outcome: PMC4394844 ('MRI of Perianal Fistulas'), section 'Classification of Perianal Fistulae' (Grade 1 = 'a simple intersphincteric fistula' penetrating between the sphincters) and the outcome statement 'grades 1 and 2 were associated with satisfactory outcome whereas grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'; simple/low-fistula fistulotomy principle from the same article.
2	Grade 2 Intersphincteric fistula with an intersphincteric secondary tract or abscess.	Still intersphincteric (no trans-sphincteric muscle involvement) but with a secondary tract/abscess that must be drained/laid open in addition to treating the primary tract; broadly grouped with the lower-risk fistulas for sphincter-sparing intent.	Favorable: grades 1-2 were associated with a satisfactory outcome (vs unsatisfactory for grades 3-5; P<0.001) in the cited series.	okfonte Criteria: PMC4394844, 'Classification of Perianal Fistulae', Grade 2 = 'an intersphincteric fistula with a secondary tract or abscess'. Outcome/risk: same article, 'grades 1 and 2 were associated with satisfactory outcome whereas grades 3-5 ... unsatisfactory ... (P<0.001)'.
3	Grade 3 Simple (uncomplicated) transsphincteric fistula (tract crosses both the internal and external sphincters into the ischioanal fossa without secondary extension or abscess).	Trans-sphincteric tracts cross the external sphincter, so simple laying-open risks incontinence (>50% with the lay-open technique for complex disease); sphincter-preserving options (e.g. seton, advancement flap) are favored, the more so with the higher grades.	Less favorable: grades 3-5 were associated with an unsatisfactory outcome (e.g. need for further surgery), in contrast to satisfactory outcomes for grades 1-2 (P<0.001) in the cited series.	okfonte Criteria: PMC4394844, 'Classification of Perianal Fistulae', Grade 3 = 'simple transphincteric fistulae'. Management/outcome: same article — incontinence '>50%' with laying-open of complex fistulas, and 'grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'.
4	Grade 4 Transsphincteric fistula with an associated secondary tract or abscess (a more complicated transsphincteric process), typically extending into the ischioanal/ischiorectal fossa.	Complex fistula: laying-open is avoided (incontinence in >50% of cases); managed with sphincter-preserving and/or staged techniques (non-cutting seton, mucosal advancement flap) plus drainage of the secondary tract/abscess.	Unfavorable: grade 4 falls in the grades 3-5 band associated with an unsatisfactory outcome / need for further surgery (vs satisfactory for grades 1-2; P<0.001) in the cited series.	okfonte Criteria: PMC4394844, Grade 4 = 'a more complicated transphincteric process with a secondary tract or abscess'; ischioanal/ischiorectal-fossa site corroborated by WebSearch summaries of St James / Morris 2000 on pmc.ncbi.nlm.nih.gov. Management/outcome: same article — complex fistulas need sphincter-preserving/staged surgery (lay-open incontinence '>50%') and 'grades 3-5 ... unsatisfactory outcome ... (P<0.001)'.
5	Grade 5 Supralevator and/or translevator disease (a complicated fistula/abscess with a supralevator or translevator component, extending above the level of the levator ani).	Most complex group: requires sphincter-preserving and often staged/specialist surgery (seton, advancement flap, treatment of the supra/translevator component) with imaging-guided planning; simple laying-open is contraindicated given the high incontinence risk.	Most unfavorable: grade 5 lies in the grades 3-5 band associated with an unsatisfactory outcome / need for further surgery (vs satisfactory for grades 1-2; P<0.001) in the cited series.	okfonte Criteria: PMC4394844, Grade 5 = 'a complicated abscess with a supra or translevator component'. Management/outcome: same article — complex/high disease needs sphincter-preserving/staged surgery (lay-open incontinence '>50%') and 'grades 3-5 were associated with unsatisfactory outcome ... (P<0.001)'.

Histórico de versões

Nenhum evento de versão registrado.

Quickstart da APIGET /api/v1/systems/stjames-fistulaaberto

curl -s "https://radcommons.laudos.ai/api/v1/systems/stjames-fistula"

Ver documentação completa