Authors present two cases of spontaneous pyeloduodenal fistulas associated to suppurative kidney disease. In both cases the fistulas developed from pyonephrosis and perirenal abscess. Diagnosis was made through intravenous or retrograde pyelogram and two patients were successfully treated by nephrectomy and primary duodenorraphy. Authors present a literature review concluding that 72 additional cases of pyeloduodenal fistulas have been described