Alveolar echinococcosis of the liver (AEL) takes a progressive and malignant course. Intra-abdominal dissemination of the parasite has a miserable outcome. Complete resection of the lesion is indispensable for the curative treatment of AEL. We experienced an extremely rare case of intra-abdominal rupture of AEL. The patient had repeated recurrences of AEL following the traumatic rupture of the lesion. After repeated resections of the lesions and appropriate medication, the patient is still alive more than 25 years since the initial onset of the disease. AEL differs from unilocular echinococcosis in terms of biological behavior. We compare the pathophysiology of the two conditions.