We report a 54‑year‑old woman with chronic pancreatitis, duodenal obstruction, massive ascites, and refractory thrombocytopenia who developed septic obstructive cholangitis after occlusion of a plastic common bile duct (CBD) stent. Endoscopic exchange failed and PTBD was prohibitively risky. Transjugular intrahepatic biliary stenting (TIBS) provides an alternative route that avoids transperitoneal hepatic capsule puncture. Via right internal jugular access, the right hepatic vein was catheterized, a posterior sectoral bile duct punctured, and a guidewire crossed the distal CBD stricture. A 12 × 80 mm self‑expandable metallic stent was deployed and the transhepatic tract embolized with coils. The patient experienced rapid clinical and biochemical recovery (bilirubin, 13.3 to 1.37 mg/dL) over 9 days postprocedure without any hemorrhagic complications. TIBS is a decisive, life‑saving alternative when standard routes are not possible.

Complex hepatic cystic lesions with inconclusive imaging pose a recurring diagnostic problem: cyst-fluid cytology and conventional core-needle biopsy seldom capture the epithelial lining needed for a histological diagnosis, and current guidelines advise against simple cyst aspiration. We describe a sheath-assisted percutaneous forceps biopsy technique for direct cyst-wall sampling under ultrasound guidance, illustrated in two male patients (76 and 48 years). After Seldinger placement of an 8 Fr sheath into the cyst, rat-tooth forceps obtained direct biopsies of the wall epithelium, and the tract was embolized with Gelfoam. Technical success was achieved in both cases; histology showed columnar biliary epithelium consistent with mucinous cystic neoplasm, whereas fluid cytology was non-diagnostic. No complications occurred. This technique offers a feasible means of obtaining a histological diagnosis in complex hepatic cystic lesions when conventional methods are inconclusive.