What could cause extreme oain under left ribcage shooting around up towards middle of back tender to the touch?

Extreme pain under the left ribcage that radiates to the middle of the back and is tender to the touch could be caused by several conditions, including gastrointestinal issues like gastritis, peptic ulcers, or pancreatitis. It might also suggest musculoskeletal problems such as rib fractures or costochondritis. Additionally, conditions related to the spleen or heart, such as splenic enlargement or referred pain from cardiac issues, should be considered. It's important to seek medical attention for a proper diagnosis and treatment.