Introduction: Emphysematous pyelonephritis (EPN) may be defined as a severe infection of the kidney that leads to necrosis and the presence of gas in the renal parenchyma, surrounding tissue, and the pelvi-calyceal system. EPN occurs almost exclusively in diabetics, but may occasionally complicate obstructive uropathy in nondiabetic patients. Case Report: We present the case of a 45 year old male with uncontrolled diabetes mellitus who presented with acute abdominal pain and free intraperitoneal air on abdominal radiograph, initially suggestive of hollow viscus perforation. He was found to have EPN that had ruptured into the peritoneal cavity. Conclusion: Acute abdominal emergencies presenting with a pneumoperitoneum are not an uncommon occurrence in emergency centres throughout the world. However, rarely, patients present with the source of the pneumoperitoneum being an organ other than bowel. These patients need to be identified as soon as possible to prevent further morbidity and mortality arising from a delay in diagnosis.Introduction: La pye´lone´phrite emphyse´mateuse (PNE) peut se de´finir comme une infection grave du rein, entrainant une ne´crose et la pre´sence de gaz dans le parenchyme re´nal, les tissus pe´rire´naux et le syste`me pelvis-calices re´naux. La PNE survient presque exclusivement chez les personnes diabe´tiques, mais peut parfois entrainer une complication de l'uropathie obstructive chez les patients non diabe´tiques. É tude de cas: Nous pre´sentons dans cet article le cas d'un homme de 45 ans souffrant de diabe`te sucre´non controˆle´consultant pour des douleurs abdominales aigue¨s et la pre´sence d'air libre intra-pe´ritone´al apparaissant a`la radiographie abdominale, sugge´rant dans un premier temps une perforation des visce`res creux. Il souffrait en re´alite´d'une PNE avec rupture dans la cavite´pe´ritone´ale. Conclusion: Les urgences abdominales aigue¨s associe´es a`un pneumope´ritoine ne constituent pas un cas rare dans les centres d'urgences du monde entier. Cependant, il est rare que la source du pneumope´ritoine soit un organe autre que l'intestin chez les patients se pre´sentant. Ces patients doivent eˆtre identifie´s le plus rapidement possible afin d'e´viter une morbidite´et une mortalite´supple´mentaires associe´es a`un retard de diagnostic. African relevanceEmphysematous pyelonephritis is a very rare and late presentation of a common disease. It presents late due to lack of access to healthcare and poor patient education. It is more common in immunocompromised and diabetic patients with greater mortality and morbidity.