Ultrasound-guided guidewire maneuver to resolve peritoneal drainage catheter obstruction in an infant: A case report

Peritoneal drainage failure is a rare but important complication in pediatric patients, and identifying its underlying cause is crucial for safe and timely management. We report a 7-month-old female infant with trisomy 13 and tetralogy of Fallot who developed respiratory failure secondary to ascites and underwent peritoneal drainage under ultrasound guidance. When drainage subsequently failed, ultrasound revealed a membranous soft-tissue structure—suspected omentum—protruding through a catheter side hole. Conventional maneuvers, including saline flushing and positional changes, were ineffective. Under real-time ultrasound visualization, a guidewire was gently advanced, restoring the membrane to its original position and re-establishing drainage. The catheter was safely removed later the same day without complications. This case illustrates the value of ultrasound for real-time diagnosis and management of catheter obstruction and suggests that a guidewire-based approach may serve as a practical and safe option when standard techniques fail.