a Abdominal computed tomography (CT) 7 months previously showed gallbladder stones and multiple cysts in the liver and the left kidney. b Abdominal CT at the time of the first admission showed a ruptured liver cyst in the right lobe (arrowhead) while it was not observed seven months previously (arrowhead). c Abdominal CT on the second admission showed that the ruptured cyst (arrowhead) was reduced with massive ascites. d Abdominal paracentesis revealed amber transparent ascites. e Drip infusion cholangiography (DIC)-CT revealed that the ruptured cyst in the right posterior segment S6 of the liver was enhanced with contrast medium (arrowhead). f, g Three-dimensional (3D) views of DIC-CT showed communication between the ruptured cyst and the intrahepatic bile duct (arrowheads, f; front view, g; lateral view). h The surface of the liver became yellowish due to bile leakage and a ruptured necrotic cyst (arrowhead) was observed on the right liver lobe. i After removing the necrotic roof, the orifice (arrowhead) that was the source of the bile leakage was identified
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