Image-guided percutaneous approach to intra-abdominal and intra-pelvic lesions has been widely used for the purpose of lesion biopsy and abscess drainage. Especially percutaneous abscess drainage has become a rapid and safe primary procedure for most abdominal infected fluid collections that used to require open surgery. In the majority of cases, lesions can be reached percutaneously avoiding intervening organs and vital structures under imaging guidance; however, several locations, such as subphrenic, posterior epigastric, peripancreatic and deep intrapelvic spaces present technical difficulties. In this article, image-guided percutaneous approach to intra-abdominal and intra-pelvic lesions is demonstrated with an emphasis on the special techniques to reach problematic locations. In addition, the basic anatomy and the current concept of the retroperitoneum are reviewed.