Spontaneous rupture of pyonephrosis leading to pyoperitoneum

Forniceal rupture after pyonephrosis can lead to retroperitoneal abscess but extension into peritoneal cavity is unusual. We present a case of 50 year old lady who presented with acute abdomen, CT scan of abdomen showed features suggestive of left pyelonephritis and large intraperitoneal collection. Laparotomy was planned on suspicion of intraperitoneal source of sepsis. Peroperatively no intraperitoneal source of sepsis was found. Retrograde pyelography showed forniceal rupture at lower pole of kidney extending to peritoneal cavity without any obstructing stone or lesion. This case highlights an unusual presentation of pyonephrosis with peritonitis and pyoperitoneum.