Differential Diagnosis for Low Back Pain Radiating to Lower Abdomen 2 Months Post-Partum

• Single Most Likely Diagnosis
  • Musculoskeletal Strain or Postpartum Back Pain: This is a common condition post-partum due to the physical strain of childbirth, breastfeeding, and caring for a newborn. The symptoms of low back pain radiating to the lower abdomen are consistent with this diagnosis, especially in the absence of other alarming symptoms like fever or significant vaginal bleeding.
• Other Likely Diagnoses
  • Endometritis: Although the patient denies fever, endometritis can sometimes present with minimal symptoms, especially if it's a partial or resolving infection. The scant vaginal spotting could be related to this condition.
  • Urinary Tract Infection (UTI): Despite the denial of urinary symptoms, some UTIs can present with minimal or no typical symptoms like dysuria or frequency, especially in post-partum women. The low back pain could be referred pain from the kidneys.
  • Ovarian Cyst: Ovarian cysts can cause lower abdominal and back pain. Given the post-partum timeframe, it's possible for hormonal changes to influence ovarian cyst formation or rupture.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although the patient is 2 months post-partum, it's crucial not to miss an ectopic pregnancy, especially if there was any chance of an intervening pregnancy. The symptoms of low back pain and scant vaginal spotting could be indicative of this life-threatening condition.
  • Pulmonary Embolism: Post-partum women are at an increased risk of pulmonary embolism. While the symptoms provided do not directly suggest this diagnosis, any unexplained pain or discomfort should prompt consideration of this potentially deadly condition.
  • Appendicitis: Appendicitis can present with atypical symptoms, including lower back pain, especially if the appendix is retrocecal. It's essential to consider this diagnosis due to its potential for severe complications if not promptly treated.
• Rare Diagnoses
  • Spinal Epidural Abscess: This is a rare but serious condition that could present with back pain and might not always have accompanying neurological deficits early on.
  • Postpartum Pituitary Necrosis (Sheehan Syndrome): Although extremely rare, this condition can occur post-partum, especially after significant hemorrhage, and can present with back pain among other symptoms due to the pituitary gland's involvement.