Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma, Perirenal tissue and its surrounding areas. We report a case of diabetes mellitus that presented to the emergency department with abdominal pain, increase urine frequency and unable to pass stool after a trivial ground level fall, was diagnosed as perforation peritonitis. Early recognition in the emergency department prompted aggressive medical management followed by perinephric drainage and DJ Stenting due to which patient was successfully treated. Early diagnosis and management is a key to the prognosis in emphysematous pyelonephritis.