ObjectiveTo discuss the diagnosis and treatment of intrabiliary hepatic hydatid cyst rupture. MethodsTwenty-five patients admitted to our hospital between 2001 and 2011 with hepatic hydatid cysts that had ruptured into the biliary tract were retrospectively reviewed. Each patient′s clinical manifestations, laboratory tests, imaging examinations, operation methods, and treatment outcome were extracted from medical records for investigation. ResultsIntrabiliary hepatic hydatid cyst rupture was diagnosed by ultrasonography (USG), computed tomography, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). ERCP clearly showed hepatic hydatid cyst rupture into the biliary fistula and had a 100% accuracy rate of diagnosis. Twenty-two patients underwent cholecystectomy, common bile duct exploration, and T-tube drainage with hepatic hydatid residual cavity drainage. The remaining three patients underwent cholecystectomy, common bile duct exploration, and T-tube drainage with hepatic hydatid foci radical resection. All patients were cured. ConclusionUSG is the preferred method for diagnosis of intrabiliary hepatic hydatid cyst rupture at our institute, despite the fact that MRCP has the advantages of being non-invasive and having high diagnostic accuracy. ERCP, however, is the gold standard for diagnosis of intrabiliary rupture of hepatic hydatid cysts. While most cases can be cured by a surgical regimen of cholecystectomy, common bile duct exploration, and T-tube drainage with hepatic hydatid residual cavity drainage, more complicated cases benefit from liver hydatid foci radical resection following the T-tube drainage procedure.