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Spontaneous rupture is a very rare complication of hepatic cysts. A total of 18 elderly patients with hepatic cyst rupture were identified from 1937 to 2019. We describe a case of spontaneous rupture of a hepatic cyst with secondary bleeding. This was detected in an 81-year-old man in whom asymptomatic giant liver cysts had been detected 2 years previously. He was admitted to the emergency department with right upper abdominal pain. Abdominal ultrasonography and computed tomography (CT) revealed rupture of the large cyst in the right liver lobe and free effusion in the peritoneal space. We performed an urgent and successful surgical intervention. The postoperative course was uneventful. Our clinical management was in accordance with the majority of other authors. Different surgical procedures have been proposed and the best approach has not yet been established. However, rupture of a liver cyst is a rare complication and prompt surgery is necessary to prevent hypovolemic shock, especially in elderly people. This case describes the decision-making process when faced with spontaneous rupture of a hepatic cyst and secondary bleeding in an elderly patient.