Obstetric sacroiliac joint injury: a case report and discussion

BACKGROUND: Sacroiliac joint injury during vaginal delivery is an uncommon but important cause of acute postpartum pelvic pain. CASE PRESENTATION: The patient is a 29-year-old gravida-6 para-3 who had an uncomplicated vaginal birth at 39.0 weeks. Shortly after delivery, the patient developed severe right-sided sacral pain. Pelvic MRI revealed tearing of the anterior sacroiliac joint capsule. CT-guided corticosteroid injection initially alleviated symptoms, but the patient developed worsening pain and recurrent fevers. Septic sacroiliitis was confirmed based on joint aspirate cultures positive for S. pneumoniae and rare Haemophilus, and the patient subsequently received intravenous antibiotics. Her recovery was protracted, requiring pain management, physical therapy, and psychiatric support. CONCLUSIONS: This case highlights the challenges in diagnosing postpartum sacroiliac joint injury and emphasizes the need for interdisciplinary management to prevent delayed treatment and reduce morbidity. Notably, this is the first reported case of postpartum sacroiliitis involving Haemophilus.