Case Report: Neonatal Biliary Ascites Successfully Managed with Ultrasound‑Guided Peritoneal Drainage

Abstract Neonatal biliary ascites is a rare but important cause of progressive abdominal distension in early infancy. Diagnosis is often delayed because jaundice may be mild and stool color may remain normal. We report a term neonate presenting with increasing abdominal distention simulating bowel obstruction and respiratory compromise secondary to massive biliary ascites. Ultrasound demonstrated large-volume free fluid without biliary duct dilatation. Diagnostic paracentesis confirmed bile-stained ascites. The infant underwent therapeutic ultrasound-guided peritoneal drainage, resulting in rapid clinical improvement and stabilisation. Subsequent hepatobiliary scintigraphy demonstrated tracer extravasation consistent with spontaneous perforation of the common bile duct. Definitive surgical repair was not required with excellent recovery. This case highlights the value of early imaging, the diagnostic role of paracentesis, and the effectiveness of minimally invasive drainage as a definitive measure without further surgery. Ultrasound-guided ascitic drainage (paracentesis) for neonatal biliary ascites is a critical diagnostic and therapeutic procedure. It involves inserting a small catheter into the peritoneal cavity under local anesthesia and real-time ultrasound visualization to safely remove bile-stained fluid. This case highlights the importance of early imaging, minimally invasive stabilization, and multidisciplinary coordination in the management of neonatal bilious ascites.