We report a case of complicated liver hydatid cyst with biliary system communication and cholangitis, having at the same time free intraperitoneal rupture. Our very rare case was treated successfully by a minimally invasive method, namely ERCP, large sphincterotomy and bile duct decompression by cysts and membranes, percutaneous radiologic subdiaphragmatic drainage and prolonged medical treatment with albendazole. Our patient, an 87 year old lady, was judged unfit for open or laparoscopic surgery, because of poor general condition.
