We report a case of right upper abdominal pain after hit by the bike handle. Her abdominal pain was resolved and was send home from our Emergency department (ED) at the first day after trauma. However 2 days after, her abdominal pain gradually worsened with accompanying high grade fever prompting her to seek consultation again at our ED. Abdominal x-ray showed gas pattern surrounding her renal shadow resembling acute emphysematous pyelonephritis. Abdominal computerized tomography proved the retroperitoneum hollow organ perforation with normal appearance of the right kidney. And after emergency laparotomy, it was confirmed that there was perforation of the 3(superscript rd) portion of the duodenum. Patient was confined in our institution for a period of 21 days and fully recovered upon discharged.