Emphysematous pyelonephritis presenting as a sonologically absent kidney

Emphysematous pyelonephritis is an acute necrotizing infection of the kidney caused by gas-producing organisms. It is being increasingly recognized as an underlying cause of sepsis. We present a case of emphysematous pyelonephritis where the affected kidney was filled with extensive gas. This made the detection of the kidney difficult by ultrasound. Also, this case presents the dilemma of managing a septic patient medically and the risks entailed in surgical intervention in such cases. Most often, these patients have underlying diabetes mellitus with underlying co-morbidities, making indicated surgical management difficult as illustrated by our patient