Spontaneous Perforation of an Acalculous Hydropic Gallbladder in a Diabetic Patient With Neuropathy: An Underdiagnosed Entity

Gallbladder hydrops (HGB) is often under-diagnosed due to the various diagnostic criteria used throughout the globe. It can be described as a progressive increase in the volume of the gallbladder in the absence of inflammation, or bacterial infection. The underlying mechanism involves biliary ductal obstruction due to gallstones. We describe a unique case of a diabetic patient who presented with symptoms of viral gastroenteritis and was incidentally found to have a non-traumatic spontaneous rupture of a hydropic gallbladder which resulted in septic shock and eventual death of the patient. We present this case together with a comprehensive literature review on why diabetic patients are at high risk of HGB and subsequent spontaneous perforation compared to the general population.