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Buttock Pain in a Thirty-one-Year-Old Woman Three Weeks Post Partum1
A thirty-one-year-old woman sought medical advice because of three weeks of pain in the left buttock. The pain started five days after her first vaginal delivery. The pain was relieved with a self-prescribed treatment of ibuprofen and remitted soon without medication. She had a history of two episodes of low-back pain two years previously. Imaging studies did not show any underlying lesion. During the pregnancy, she gained 15 kg (1.6 kg in the last week), without complications except for one lower urinary tract infection that resolved with antibiotic treatment. The patient did not experience pelvic or spinal pain during the pregnancy, and there was no history of trauma or endocrine or metabolic diseases. No smoking or use of heparin was reported. At the end of the fortieth week of the pregnancy, she was admitted after spontaneous rupture of the membranes. She was in active labor for 9.5 hours. Epidural analgesia was used. No instruments or unusual maneuvers were used to deliver a healthy 3125-g baby girl.
On physical examination of the woman at three weeks post partum, the left sacroiliac joint was painful with the slightest movement with no other relevant findings. Plain radiographs of the pelvis showed bone density asymmetry with increased intensity in the left sacral wing. A pelvic magnetic resonance imaging scan was performed.
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The results of blood tests were normal for cell counts, inflammatory markers, calcium, and phosphorus levels. The results of renal function tests were also normal.
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