The aim of this study was to evaluate the clinical presentation of, predisposing factors in, and early and long-term outcome of patients treated surgically for intraperitoneal ruptured liver hydatid cysts. Medical records of 27 patients with traumatic rupture of hydatid cysts were evaluated retrospectively, as were records of 347 patients with nonperforated hydatid cysts. The ratio of perforation cases to nonperforation cases was 7.8%. Traffic accidents were the most common cause of perforation (n = 16). All patients had abdominal findings, and two patients (7%) had anaphylactic findings. The sensitivities of computed tomography and ultrasonography were 100% and 93%, respectively. Conservative surgical procedures were used for 80.5% of cysts and radical procedures for 19.5%. Associated organ injuries were determined in 10 patients. No significant difference was found between patients with peritoneal perforation and those without perforation in terms of sex (p = 0.403), previous hydatid disease surgery (p = 0.565), localization (p = 0.241), number of cysts (p = 0.537), presence of cystic content infection (p = 0.65), or presence of bile duct communication (p = 0.37). However, there were significant differences in age (p = 0.004), cyst diameter ( > 10 cm) (p = 0.03), and presence of superficially localized cysts (p = 0.011). Three patients developed recurrence. In the group of patients with perforation, the complication and recurrence rates were not statistically different in a comparison of surgical techniques (p = 0.37). No postoperative deaths occurred. The main predisposing factors for cyst perforation are young age and superficial localization. Peritoneal rupture increases the rates of postoperative morbidity and recurrence; in contrast, there was no significant relation between the operative procedure and the morbidity and recurrence rates.