Diverticulitis Surgery Necessity Protocol? I researched it with AI.

I used Gemini AI to assess current protocol on surgery for diverticulitis using sources from Mayo Clinic, Johns Hopkins, and Cleveland Clinic. My synopsis is immediately below. Evidently you can't post a discussion with a link because this would just 'spin' and not post until I took it out. But evidently you can put a link in comments to discussions - so see my comment below for the link to the AI discussion if you want to view it and continue it with your own follow-on questions.

- MY SYNOPSIS: The chat results describe surgery recommendations or requirements in the categories of Unnecessary, Necessary and Emergency, as numbered and defined here:

1. Unnecessary: Mild-Moderate episodes successfully treated with diet and antibiotics.
2. Necessary: 1) Fistula develops, 2) Stricture develops, or 3) Significant enough disruption of Quality of Life.
3. Emergency: 1) Perforation causing peritonitis, 2) Complete obstruction, or 3) Abscess that can’t be drained.

The follow-on questions resulted in describing the risks and conditions of "Unnecessary" cases moving up to “Necessary” and “Necessary” up to “Emergency”: Those are lettered and described here:

A. Risks and Conditions Associated with "Unnecessary" Cases Moving Up to “Necessary” Cases:

a) Fistula: Often the result of "smoldering" or chronic inflammation rather than a one-time explosion. Multiple episodes in the same spot can weaken the wall between the colon and bladder, potentially leading to a fistula between those organs.

b) Stricture: Every time your colon gets inflamed and heals, it can create scar tissue. Over many years and episodes, that scar tissue can build up, narrowing the colon (a stricture) and eventually leading to a bowel obstruction.

c) Quality of Life: A personal decision based on the level of life disruption.

B. Risks and Conditions Associated with “Necessary” Cases Moving Up to “Emergency” Cases:

a) Perforation: Having a Fistula or Stricture does not significantly increase this risk of sudden, free-falling rupture into the abdominal cavity (peritonitis). Fistulas and Strictures are results of "contained" inflammation. Your body has already demonstrated an ability to wall off the infection with scar tissue or by sticking to an adjacent organ. If a perforation is going to happen it most often happens during the first episode. If you already had 2 or 3 "uncomplicated" episodes treated successfully with diet and/or antibiotics and didn't result in a “hole”, your 4th or 5th episode is statistically likely to be uncomplicated as well. So multiple episodes increases the risk of having another flare-up, but not significantly your risk of a life-threatening emergency of a perforation or rupture.

b) Obstruction: If you have a Stricture, your risk of an emergency bowel obstruction increases Substantially. THE TIPPING POINT: A Stricture can turn a manageable situation into an emergency if:

i.) Inflammation Spikes: A minor flare-up causes the already-narrowed area to swell shut completely.
ii.) Impending Rupture: If the blockage is "complete," pressure builds up behind the stricture. This can cause the healthy part of the colon above the blockage to stretch and potentially tear—a different, very dangerous type of perforation. Institutional Guidance - Because of this risk, the Cleveland Clinic and Johns Hopkins generally move surgery from "last resort" to "strongly recommended" once a stricture is identified, to prevent a predictable future blockage.

c) Abscess: The relationship between these conditions is actually somewhat circular: Abscesses often cause fistulas and strictures, and once those structural issues exist, they can lead to new or persistent abscesses.

- KEY TERMS USED ABOVE:
- Fistula: An abnormal tunnel or "bridge" that forms between two organs that shouldn't be connected. In diverticulitis, chronic inflammation causes the colon to stick to a neighboring organ and eventually wear through a path. Common types: Colovesical-Colon and bladder (may cause air or stool in urine); Colovaginal-Colon and vagina; Coloenteric-2 different parts of the bowel.

- Stricture: A narrowing of the colon. After multiple bouts of diverticulitis, the healing process creates scar tissue. This scar tissue can thicken and "cinch" the colon, making the passageway much smaller. Significance: This can lead to thin, ribbon-like stools or contribute to a full blockage.

- Perforation: A hole or tear in the wall of the colon, usually due to inflammation from diverticulitis weakening the tissue until it gives way. Significance: This is a serious event because it allows bacteria, waste, and pus to leak out of the intestine and into the sterile abdominal cavity.

- Obstruction: A partial or complete blockage of the bowel that prevents food, gas, and stool from passing through. Causes: In diverticulitis, this can be caused by a stricture (scarring) or by severe swelling and inflammation during an active flare-up that physically closes off the colon.

- Abscess: A localized pocket of infection and pus that forms near the site of the inflamed diverticulum. It is the body’s way of "walling off" an infection. Significance: While small abscesses can sometimes be treated with antibiotics, larger ones may require a doctor to insert a needle or tube through the skin (guided by imaging) to drain the fluid.

- Peritonitis: A life-threatening emergency where the lining of the abdominal cavity (the peritoneum) becomes severely inflamed or infected. Significance: It is often the direct result of a perforation. When stool or pus leaks into the abdomen, it causes widespread infection that can lead to organ failure if not treated immediately with surgery and heavy antibiotics.

PERSONAL NOTE: I am not advocating surgery but had I been more thoroughly aware of these details I would have done surgery at least 3 or 4, maybe 5 or 6 flareups ago. I’ve had 10 or more in as many years, depending on what you count. I now understand that once it was obvious that they were not going to end, and repeated flareups only increased my risk of stacking conditions that could lead to an emergency surgery. That combined with the fact that the body’s ability to get through and recover from surgery does not get better with age. I now have a stricture, bad enough and developed close enough to my already scheduled surgery that we had to delay surgery and do tests to rule out that it was an infection. We delayed it 3 weeks, ruled out infection, and it is scheduled early January 2026. But I’m at risk until surgery of developing an infection and changing this from awaiting a Necessary scheduled laparoscopic surgery with my own colorectal surgeon to having to get an Emergency unscheduled open-surgery with whatever surgeon is on duty at whatever hospital can take me when it happens.