Forty-one patients presented with jaundice or/and cholangitis after rupture of a hydatid liver cyst into the bile ducts. Preoperative diagnosis has recently been based on ultrasound and CT scan. Seventeen patients had drainage of the common bile duct by a T-tube (group A) and the remaining 24 had choledochoduodenostomy (group B). The primary liver cyst was dealt with by removal of the endocyst and either simple drainage (4 in group A, 7 in group B), or omentoplasty (6 in group A, 11 in group B). Of group A, there were 2 patients with nontreated jaundice, 7 with recurrent jaundice – 3 of whom with an external bile fistula – and 3 patients with recurrent episodes of cholangitis. Of group B, there were 2 patients with recurrent jaundice and 1 patient with recurrent episodes of cholangitis. Differences between the two groups were statistically significant (p < 0.01). Complicated cases underwent additional choledochoduodenostomy (8 patients in group A and 2 patients in group B, who had their choledochoduodenostomies revised), interventional endoscopy (4 patients) and omentoplasty (4 patients – 1 reoperation). There were 3 deaths (2 after reoperation). One patient died because of secondary biliary cirrhosis, another because of multiple intrahepatic abscesses and the third becasue of pancreatitis. It is concluded that along with the treatment of the liver cyst per se, intrabiliary rupture of a liver hydatid cyst is better treated by choledochoduodenostomy than by simple T-tube drainage of the common bile duct. The latter method results in recurrent jaundice and cholangitis, which are well treated by adding choledochoduodenostomy.