<s>[INST] Hi, We are dealing with something of a medical mystery.  The patient is 54 year old male.  Has upper left abdominal pain for 4 months with 25 pound weight loss.  Pain is chronic and localized.  Unrelated to food intake or body position.  No diarrhea, vomiting, nausea, reflux, or other GI changes.  Negative Upper and Lower endoscopies, negative H pylori; negative EUS; negative MRI of pancreas.  Negative Pill camera swallow.  Normal bloodwork including liver and pancreatic enzymes with exception of borderline high sugar. Imaging all negative (CT, MRI, Ultrasound of celiac artery).  Pain presented in days following a throwing injury that pulled oblique muscle on same side.  Muscular pull healed within days.  Negative Carnetts sign. MRI of Thoracic spine negative. Trial of Celebrex ineffective.  Any guesses? [/INST] The pain can be due to fibrosis of the muscles after healing. On exploration, they appear pale and hard to touch. Or can have a small hernia trapping the mental fat which is easily missed on USG and MRI unless specifically scanned for. The weight loss may not be explained by this. It can be due to high sugar, particularly the postprandial. OG TT (oral glucose tolerance test) and other investigations for blood sugar may help. Maybe the patient has a fear-factor or phobia causing this much weight loss. </s>