Complications of diagnostic and therapeutic paracentesis include bowel perforation, hemorrhage, and death. At present, medical practitioners identify an area for paracentesis using either physical examination alone or with the addition of ultrasound. The preferable method is still debated within the medical literature. This case series compares photographs of patients with abdominal distension, diagnosed as ascites by physical examination, to the respective ultrasound findings. The ultrasound images show a variety of findings: large volume ascites, bowel loops extending to the abdominal wall (unilaterally or bilaterally), and distended bowel loops due to intestinal obstruction in the absence of substantial ascites. Studies have shown that performing ultrasound before ascites paracentesis procedures improves the procedure success rate and reduces complications. This case series illustrates examples of why ultrasound-assisted paracentesis has a better safety profile and a lower procedure failure rate, compared to physical examination techniques alone.