Biliary peritonitis is one of the infrequent types of acute abdomen. It is encountered in particular in older people and is associated with a high lethality. The diagnosis is difficult because the symptoms are not typical and frequently not very expressed. The importance of the disease is enhanced by the fact that a certain percentage of the cases develops as a complication and direct consequence of medical intervention. As several of these cases were encountered at our clinic in recent years and we had the opportunity to observe the "natural" course of the disease up to the lethal end in a female patient who refused all invasive diagnostic and therapeutic interventions, we present the clinical picture of the disease incl. auxiliary and laboratory examinations and the course of the disease.