OBJECTIVE. We studied the sonographic findings of symptomatic intestinal metastases and the use and safety of subsequent sonographically guided 22-gauge fine-needle aspiration or 18-gauge core biopsy. CONCLUSION. Symptomatic intestinal metastases can be diagnosed by transabdominal sonography. Extensive hypoechoic segmental bowel wall thickening with loss of stratification and intussusception can be observed. Sonographically guided fine-needle aspiration or 18-gauge core biopsy performed at the end of the examination allows definite diagnosis and is a safe procedure.