Question: Patient is a 21 year old Caucasian female. Presented with acute abdominal pain 2.5 years ago. Pain focal point is located anterior of left 3 inches from midline, beneath the 12th rib, near spleen. Pain in this spot is described as intense 'stabbing' sensation, but appears only in brief and violent episodes lasting between 3-5 minutes. This area is always extremely sensitive to the touch, described as feeling deeply bruised. Spreading from the epicenter is a dull aching pain that is constant, extending towards the posterior along the T10 intercostal nerves and upwards under the left armpit. Patient has also experience twining sensations in clavicle during the acute attacks.
Other symptoms, in order that they first appeared, following the initial presentation 2.5 years ago: Bright red blood in stool, diarrhea, tachycardia, and most recently panic attacks that precipitate the acute pain attacks. During the attacks the patient exhibits a short (1-3 minute) period of decreased responsiveness towards outside stimulus (does not talk, move, respond to touch, make eye contact). After this, the attack precedes with hyperventilating which exasperates the abdominal pain. Patient CAN remember all the events of the attack, but either is in to much pain OR, temporarily neurologically impaired, to respond to stimuli.
EEG was unremarkable, no signs of seizure activity. It should be noted that an attack DID NOT occur during the EEG. Overnight study has been scheduled. Multiple MRI's of abdomen, with and without contrast material, have been unremarkable. Full T-spine X-ray revealed small Sphinx at T4, believed to be present since birth and unrelated. endoscopy and colonoscopy were unremarkable, however biopsy samples have been sent to lab for further testing. Blood tests have not pointed towards infection. Blood tests negative for Anemia, STD's. T-10 intercostal block (litocaine with steroids) administered, only marginal reduction in pain. Pain management is considering spinal nerve inhibitor implant. Patient was attending physical therapy to regain muscle strength know left shoulder and back after muscles began to adrift from underuse, as she favored her right side to avoid exasperating the pain. Patient's mobility has suffered, walking up stairs or for distances greater than one mile can trigger the acute attacks. Sleeping pattern has been disrupted. Patient has been on the following medications, in order first administered: Motrin, Gabupentin, Topamax. Patient was taken off TOPOMAX because it was believed to have have made the panic attacks worse. Patient showed slight improvement at first, then deteriorated without a block to the pain. All medication has only been marginally successful in demolishing pain. No rashes or skin discoloration present. No abnormal eye color. No speech impairment. Patient has been scheduled for urine test for Acute Intermittent Porphyria. Family history of Endometriosis, Mother, abnormal presentation. Debating exploratory surgery to confirm in patient. Patient was diagnosed with Epilepsy at age of 4 and remained on anti-seizure medicine (gabapentin) until age 8. during this time, treatment was successful and no seizures occurred. No relapse after being taken off gabapenton.

Any insights would be greatly appreciated.