Pancreaticoduodenectomy was associated with an increased morbidity, and septic complications are the primary cause of death in these patients. However, severe sepsis, caused by a postoperative urinary tract infection, is uncommon. It is presented the case of a 72 years old man, with a pylorus-preserving pancreaticoduodenectomy for an ampullary adenocarcinoma. Postoperatively, the patient developed a chyle leak, and a severe urinary tract infection (i.e., emphysematous cystitis), with septic shock. The diagnosis, management and outcome are discussed. In conclusion, emphysematous cystitis is a potentially life-threatening complication, which may occur due to the postoperative immunodepression after pancreaticoduodenectomy.