Background: The uniqueness of this case is in its rarity and divergent presentation.
Case presentation: Here, we report a case of 56-years old male patient with pain in the Left flank for 1 year. On evaluation, patient was diagnosed with multiple left renal calculi and emphysematous pyelonephritis with Nonfunctioning kidney. Intraoperatively, dense perinephric adhesions, necrotic kidney and reno-colic fistula were encountered. The patient underwent Left nephrectomy with resection anastomosis of descending colon segment with loop ileostomy. Histopathological examination showed a poorly differentiated high grade clear cell carcinoma with squamous metaplasia.
Conclusion: Renal cell carcinoma can present in unusual ways. Sometimes, it can mimic emphysematous pyelonephritis because of fistulous communication with gut.  It’s rare but challenging for urologists to diagnose and manage such cases.
Keywords: Renal cell carcinoma, Reno colic fistula, Non-functioning kidney, Emphysematous pyelonephritis, Case report