This patient had been extensively investigated prior to attending the pain clinic and sinister pathology had been ruled out. Sinister causes of chronic bloating including ovarian pathology, sub-acute bowel obstruction, colitis and ascites.
The working diagnosis with this patient is that of irritable bowel syndrome. She may have had some flare ups of diverticulitis but this was not evident at presentation or during investigation. Another potential contributor to her pain could be autonomic neuropathy due to the diabetes and potential side effects of Metformin of which she was on 850mg twice daily and indeed had been on this drug for as long as she has had the abdominal pain and bloating.