Brief Answer:
Have two suggestions; and a list of possibilities

Detailed Answer:
Hello and welcome.

Thank you for writing to us.

I have gone through your query and would like you to know that I am here to help. I am extremely sorry to hear that your father is going through this. I would like to say that with diverticulitis itself, most of your fathers symptoms can be related, except that the pain with diverticulitis is mild and mostly just discomfort and not so severe, which is why it does raise some doubt towards assuming diverticulitis to be the cause for his symptoms.

Let me go ahead an list all the conditions that can cause abdominal tenderness for your reference:

+Appendicitis (would have been found or ruled out by CAT scans)
+Peritonitis: Also should have been noticed
+Hepatitis
+Toxic megacolon
+Hernias
+Liver abnormalities
+Diverticulitis: Can also cause abdominal tenderness along with nausea, diarrhoea and lower left side (predominantly) abdominal pain
+Parasitic infections
+Kidney abnormalities
+Ischemic colitis

But, I should rightly mention that almost all of these conditions should have been observed on the investigations mentioned by you, so there is nothing new that can be found that the investigations your father has already undergone can find.

On that note, I have two suggestions:

1. Why don't we go ahead and concentrate on treating the diverticulitis which is currently the only abnormality we have and can be easily related to almost all the symptoms he is experiencing?

2. Please do not misunderstand my suggestion as I only speak in your fathers best interest. But have you considered a psychological approach? I only mention this because, in my practise I have come across numerous patients who have reported with severe pain and all the possible symptoms of a condition, but not one laboratory investigation has been able to find even one abnormality. These patients, when treated with anti-depressant medications responded amazingly. Let this remain between only you and me, but would you just for my satisfaction rate your fathers level of happiness or possible depression on a scale of 0 to 5.

0 being extremely depressed, and 5 being very happy all the time.

I hope you find my response both helpful and informative. I look forward to hearing from you further in order to be able to provide more information that can help your father. Please do not hesitate to write to me with any extra information that can be relevant.

Best wishes.

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Brief Answer:
I have commented on each of the possibilities put forward sir/ma'am

Detailed Answer:
Hello once again.

Thank you so much for that information, and also taking my suggestions in good stride.

I would like to comment on each of the possible conditions for your better understanding.

+Gastritis: Can certainly cause excruciating pain at times, but should have been diagnosed by the scopes (as mentioned by you)

There are two types of gastritis, one is autoimmune and the other is caused by a bacteria (H. pylori). Most common treatment regimens include the use of two types of antibiotics, an antacid and a drug that promotes healing

+Peptic ulcer: Can cause severe pain, but once again should have been diagnosed on an endoscopy (easily)

+Helicobacter Pylori infection causes type B gastritis as mentioned earlier

+Intestinal ischemia/ischemic colitis: Is a possibility and I have mentioned it in my previous response sir/ma'am

+Inflammatory bowel syndrome: Consists of two types (Ulcerative colitis and Crohn's disease), both of which have the same symptoms. I can say this not only with the medical knowledge I have but also my personal experience as I have been suffering from ulcerative colitis for over 8 years now, the pain is not that excruciating

+Aortic dissection: Pain is mainly in the chest and upper back region, not as your father seems to be experiencing in the abdominal and lower back region. Other symptoms include shortness of breath, difficulty speaking, loss of consciousness, loss of vision, etc. It is not a possibility in my opinion, and would not explain the abdominal tenderness, diarrhoea, etc. Ruled out in my opinion

+Celiac disease: Also does not match the symptoms your father is presenting with sir/ma'am. Symptoms include weakened bones, acid reflux, headaches, tiredness, teeth enamel changes (mainly discolouration), numbness in hands and feet, joint pain, heartburn, etc. In my opinion, should be ruled out

+Henoch-Schonlein purpura: Your father has only 1 of the 4 main presentations. Please check on kidney health, rash and painful swollen joints to consider this diagnosis. If others are not present, this condition should also be ruled out

+Cancer: Should have been seen on the CAT scan, and will be accompanied by severe weight loss (reaching half the body weight in 6 months time)

+Porphyria: Can only be partly considered, and a urine and blood test to look for porphyria should be considered

I hope this information helps guide you forward sir/ma'am. Please do not ever hesitate to write to me for any further clarifications, I am always here to help.

Best wishes.

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