Figure 2.

Axial CT and CT-fluoroscopy images illustrate the management of two complex cases in whom the endoscopic approach was not feasible: (a) perigastric accumulation of ascites (black star) constrains the punction field to the stomach (white star) and poses the risk of breakage; (b) after paracentesis, insufflation of the stomach using the nasogastric tube; (c) tacking the stomach to the anterior abdominal wall with gastropexy sutures; (d) image shows the kissing-spleen hepatomegaly (triangles) narrowing the punction field in another patient; (e) puncture of the stomach is only possible via 9th intercostal space (arrow); (f) image demonstrating the successfully positioned G-tube with the inflated balloon in gastric lumen.