# Tumor Lysis Syndrome Following Endoscopic Retrograde Cholangiopancreatography With Stent Placement in a Patient With Cholangiocarcinoma: A Case Report

## TL;DR

A rare case of tumor lysis syndrome occurred after an ERCP procedure in a patient with cholangiocarcinoma, highlighting the need for early recognition and intervention.

## Contribution

This case report documents a rare occurrence of TLS following ERCP in a cholangiocarcinoma patient.

## Key findings

- TLS developed within 24 hours after ERCP with stent placement in a patient with cholangiocarcinoma.
- Despite aggressive management, the patient died 24 hours post-procedure, emphasizing the severity of this complication.
- The case underscores the importance of clinician awareness of TLS as a potential risk in similar procedures.

## Abstract

Tumor lysis syndrome (TLS) is an oncological emergency commonly associated with hematologic malignancies and aggressive chemotherapy. Its occurrence following endoscopic retrograde cholangiopancreatography (ERCP) with stent placement in patients with cholangiocarcinoma is exceedingly rare, with only a handful of cases reported in the literature. This report discusses a unique case of TLS occurring after ERCP in a patient with cholangiocarcinoma, highlighting the clinical challenges and the need for heightened awareness among clinicians. Herein, we present the case of a 58-year-old female patient with a diagnosis of cholangiocarcinoma who developed TLS following ERCP with stent placement. The patient initially underwent the procedure to relieve biliary obstruction, a common palliative intervention in cholangiocarcinoma cases. Within 24 hours post-procedure, the patient exhibited signs of acute renal failure, hyperkalemia, hyperphosphatemia, and hypocalcemia, consistent with TLS. Prompt recognition and aggressive management, including hydration, electrolyte correction, and renal support, were crucial in stabilizing the patient. Despite prompt recognition and aggressive management, including hydration, electrolyte correction, and renal support, the patient unfortunately passed away 24 hours later. This tragic outcome underscores the critical importance of early recognition and intervention, as well as the need for awareness of this rare but possible complication. This case highlights the rare but serious risk of TLS following ERCP in patients with cholangiocarcinoma. Clinicians should be aware of this potential complication, especially in patients with a high tumor burden or those undergoing palliative procedures. Early recognition and intervention are paramount in improving patient outcomes. Further studies are needed to better understand the mechanisms and predisposing factors for TLS in this context.