Pigtail Catheter for Treatment of Massive Postpartum Ascites: A Rare Case Report in Somalia

Postpartum ascites is a rare but potentially serious complication characterized by the abnormal accumulation of fluid in the peritoneal cavity following childbirth. The condition may result from various etiologies, including infections, liver dysfunction, preeclampsia-related syndromes, and malignancies. In resource-limited settings, its diagnosis and management pose unique challenges. This case report aims to highlight the successful use of a pigtail catheter for continuous drainage in managing massive postpartum ascites of infectious origin in Somalia.

A 35-year-old multiparous woman (G9P6) presented seven days postpartum with abdominal distension, fever, nausea, and vomiting. All symptoms began acutely on the second day after an uncomplicated full-term spontaneous vaginal delivery. Initial assessment revealed signs of systemic inflammation, leukocytosis, and hypoalbuminemia. Abdominal ultrasound and CT imaging confirmed massive ascites with thick septations, raising suspicion of abdominal tuberculosis or peritonitis. Despite initial empiric antibiotics and large-volume paracentesis, her condition worsened. A percutaneous pigtail catheter was placed under ultrasound guidance, allowing continuous controlled drainage (up to 2000 mL/day). The patient showed progressive clinical and laboratory improvement with antibiotic escalation and supportive care, including albumin infusion. Serial ultrasounds demonstrated gradual resolution of ascites, and the catheter was removed after six weeks with no recurrence.

This case underscores the importance of a systematic, multidisciplinary approach to postpartum ascites, particularly in settings with limited diagnostic resources. The use of a pigtail catheter provided an effective, minimally invasive method for managing refractory ascitic fluid, reducing the need for repeated paracentesis and its associated complications. This technique serves as a viable therapeutic strategy in resource-limited environments where conventional management may be constrained. Early intervention with imaging-guided drainage and targeted therapy can be life-saving. Further research is needed to guide standardized management protocols for postpartum ascites.