Differential Diagnosis for Left Iliac Fossa Pain Post-C-Section
Single Most Likely Diagnosis
- Iliopsoas hematoma or iliopsoas irritation: The pain in the left iliac fossa that subsides when pressure is applied to the left iliac crest suggests a possible irritation or hematoma of the iliopsoas muscle, which could have been injured during the C-section. The iliopsoas muscle runs from the lumbar spine, over the pelvic brim, and inserts on the lesser trochanter of the femur, and its irritation can cause pain that radiates to the lower abdomen and groin.
Other Likely Diagnoses
- Diverticulitis: Although less common in young women, diverticulitis can cause left lower quadrant pain. However, the pain typically does not improve with pressure on the iliac crest.
- Ovarian cyst or torsion: These conditions can cause acute pain in the lower abdomen but are less likely to be directly related to a C-section or to improve with pressure on the iliac crest.
- Constipation or bowel obstruction: Postoperative constipation or a bowel obstruction could cause abdominal pain, but the specific pattern of pain improvement with iliac crest pressure is not typical.
Do Not Miss Diagnoses
- Internal hernia: Although rare, an internal hernia through a defect in the abdominal wall or a port site from the C-section could cause bowel obstruction and severe pain. It's crucial to consider this diagnosis due to its potential for serious complications.
- Intra-abdominal infection or abscess: Postoperative infections can cause persistent pain and fever. An abscess in the pelvic region could cause left iliac fossa pain, and while the pattern of pain relief with pressure on the iliac crest is not typical, missing an infection could have severe consequences.
- Ureteral injury: A ureteral injury during the C-section could lead to urine leakage, infection, or obstruction, causing abdominal pain. This is a critical diagnosis not to miss due to the potential for long-term damage to the urinary system.
Rare Diagnoses
- Nerve entrapment or neuropathy: Direct injury to nerves during the C-section or subsequent scar tissue formation could lead to neuropathic pain in the distribution of the affected nerve.
- Endometriosis: Although endometriosis can cause chronic pelvic pain, it is less likely to be directly related to a recent C-section or to present with pain that improves with pressure on the iliac crest.
- Musculoskeletal issues: Other musculoskeletal problems, such as a stress fracture of the iliac crest or a lumbar spine issue, could cause pain in the left iliac fossa but would be less directly related to the C-section.