"Just" IBS, or something else?

Hello,

I'm a 27 year old, 165 pound male with a history of lower back pain from an injury, but otherwise generally healthy and active. About 18 months ago, I started having burning and sharp pains near my belly button. Shortly after this pain started, I noticed a sharp LRQ pain (directly between by hip and belly button). That evening, I went to the ER, where I had an abdominal CT scan and some blood work to rule out appendicitis. The labs and CT came back normal, so I was offered pain medication (which I refused) and was sent home.

Over the next month, LRQ pain continued but the belly button pain went away. I discussed the pain with my GP, who suggested another abdominal CT scan. This CT also came back clear, so he referred me to a General Surgeon.

During my exam with the surgeon, he found a small inguinal hernia on my right side. While pushing on the area he found, he was able to simulate the LRQ pain. Because of this, we were hopeful that it may have been the cause. About 6 months after the original pain began, I underwent laparoscopic surgery to repair the hernia with mesh. During my initial recovery, I was taking Ibuprofen regularly and felt great the first couple of weeks. I stopped taking any medications by the second week and started feeling the original LRQ pain again shortly after.

After a few months of recovery with no relief from the pain, I started making follow up appointments to have some additional testing done. The surgeon felt that the pain was likely just recovery pain, but I was never convinced.

Now, over 18 months later, my pain has increased in frequency and intensity. I'm experiencing frequent fatigue and I'm starting to have trouble doing some of the things I'm used to doing at work and home. The pain has also spread from the original location, all the way to the bottom of my right rib cage. The pain also tends to affect my lower back and side. During this period, I have experienced some digestive issues (alternating diarrheaa and constipation, gas/bloating), as well as occasional sharp groin pains and slight difficulty urinating. I have not been able to specifically relate the pain or digestive issues to certain foods, though eating large meals or fatty/greasy foods tend to make me feel worse in general.

Over the last 18 months, I've been to my GP, two different General Surgeons, a Gastroenterologist, a Spine Specialist, and a physical therapist. I've had the two abdominal CT scans, an abdominal ultrasound, a fecal occult blood test, a colonoscopy, a SIBO breath test, a full spine X-Ray, a lower-lumbar MRI, and now recently a HIDA scan. I have been told all my tests have been "normal", with the exception of some issues with my lumbar spine, which was not a surprise.

I have asked about many possible causes, such as chronic appendicitis, ulcers, gallbladder issues, mesh rejection/infection, etc and have gotten nowhere. My GI doctor has suggested that my pain could be "just" IBS and prescribed Bentyl about 8 months ago to try. I took it for about a month and felt zero change so we decided to stop it. The spine specialist prescribed muscle relaxers in case some of the pain was back related and again I felt zero change so I stopped after about 10 days.

My recent HIDA scan shows my gallbladder ejection fraction is 82%. I've read about Hyperkinetic Biliary Dyskinesia and plan on asking about that as a possibility. As far as this possibly being "just" IBS, does that generally cause consistent, reoccurring pain in specific areas (that can be elevated by pushing on the areas) and only other a few, mild "typical" symptoms of IBS?

One of the general surgeons, my GP, and spine specialist have recommended another abdominal CT (as it's been over 17 months since my last) as my next step. My current GI doctor has recommended waiting on the CT and has referred me to a second GI doctor for another opinion.

I'm not opposed to another CT as I think it would help put my mind at ease, but I am concerned about the radiation of all of these tests. I'm wondering if there are any other tests (additional ultrasounds, MRIs, or even blood work) that I should be suggesting. None of the doctors had any other suggestions when I asked them. Is three CT scans in 18 months unreasonable, considering the other testing I've had?

Any thoughts, experiences, or suggestions would be greatly appreciated! I'm really unsure of what to do next and I am starting to have hard time keeping a positive attitude. Feeling better would be great, but definitely want to rule out anything serious and keep this from getting any worse!

Thank you for your time and help!

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