Background: Caesarean section is one of the most common surgical procedures and it can be complicated by postpartum haemorrhage, requiring additional suturing. Retained surgical needles during Caesarean section (CS) are rare but serious complications, and are particularly challenging in low-resource settings. We present a case managed in a remote hospital in Lamu County, Kenya without access to advanced imaging or specialist input at the time of surgery. Case Presentation: A 26-year-old patient underwent emergency CS at 38 weeks for failure to progress. Postpartum haemorrhage from the placental bed in the posterior uterine wall happened and required suturing. Unfortunately, the needle became detached and was lost within the myometrium. The needle could not be retrieved intraoperatively because of continuing bleeding, leading to poor visibility and the need to close the uterus. Therefore, the decision was made to leave it in situ for later retrieval. Further evaluation and discussion with a multidisciplinary team were conducted. Surgical removal was performed because of the potential risks. No advanced imaging including CT or fluoroscopy was available, and ultrasound scanning was successfully used to localize the needle preoperatively and also guide the retrieval intraoperatively, through a posterior uterine wall incision. The patient's recovery was uneventful and she was discharged on the third postoperative day. Conclusion: This case illustrates the feasibility and effectiveness of using ultrasound to manage a retained uterine needle in a low-resource setting. Real-time ultrasound is safe, minimally invasive, and available, and helps avoid complications. Early communication with the patient and multidisciplinary teamwork were key to successful outcomes.