The morbidity and mortality of unusual clinical cases ranges from five to sixfold times those of usual clinical cases. Noneless, there is an acute lack of structured information sources on the best managing practices for those cases. The general objective of ELCANO is to build and exploit a multilingual Virtual Library of outstanding clinical guidelines to manage unusual cases. This Virtual Library will be distributed across The Internet from the partners servers and accessed by specialists and specialists in training. Gastroenterology will be the initial area of the clinical practice to be addressed. The unique and innovative aspects of ELCANO are its orientation toward unusual cases, the framework embracing countries from Europe and Latin-America, the structured pre-validation of the cases and its multilingual contents as well as their indexing and codification using internationally accepted standards. An immediate benefit from ELCANO will be the availability of critical clinical information in places where there is a lack of experience coming from places where this experience is commonplace. ELCANO is to be regarded as a exploratory measure, to test the implementation of North-South and South-North collaboration in telecommunication of clinical information. When successful, a broader range of medical specialities and more countries in both regions as well as new regions are foreseen to be involved. © The authors 1996.