- In four patients, acute cholangitis was found to result from a ruptured hydatid cyst. In three patients, the diagnosis was established before operation by ultrasonography, and the fourth case was diagnosed during operation. Once the diagnosis of cholangitis is reached, our working policy includes administration of antibiotics and fluids, accelerated diagnostic workup, and operation as soon as possible. Our suggested operative procedure is cholecystectomy, choledochotomy, choledochoduodenostomy, and removal of the echinococcal cyst. In all four cases treated by us, there were no deaths, and only one patient who did not undergo removal of the echinococcal cyst at the initial operation needed a second operation 2 months later.