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Pyeloduodenal fistulae are rare and usually occur between the right renal pelvis and the duodenum due to their anatomical proximity. Pyeloduodenal fistula occurring due to local extension of emphysematous pyelonephritis has been described as a rare entity. Conservative management is preferred for management of emphysematous pyelonephritis and pyeloduodenal fistulae if renal function is adequate. We describe a case of emphysematous pyelonephritis of the right kidney complicated by a spontaneous pyeloduodenal fistula and perinephric air and urine containing collections managed conservatively with percutaneous nephrostomy and percutaneous drainage of perinephric collections.