Spontaneous rupture of the ureter is a rare urological occurrence with minimal number of cases reported in the literature. It is happened when there is extravasation of urine from the ureter which occurs without trauma or iatrogenic manipulation of the ureter. It often occurs secondary to ureterolithiasis with urinary tract obstruction and resultant increased intraluminal pressure and subsequent rupture. Rupture may occur anywhere along the urinary tract, with the commonest sites being the fornices and upper ureter. It may lead to urinoma, infection with sepsis, acute kidney injury and abscess formation if left untreated. We present a case of 38 years old female who came with acute flank pain and acute abdomen to the emergency department. She also suffered nausea, vomiting, fever, and chills. Laboratory examination was otherwise normal except for the increase of serum creatinine level. Intravenous pyelogram was done and showed extravasation of contrast material at the proximal ureter level. Left midureteral stone and left hydronephrosis was also revealed from abdominal CT scan. The patient was successfully managed by ureterorenoscopy, lithotripsy for the stone, and insertion of double-J stent. Spontaneous ureteral rupture should be kept in mind as a differential diagnosis in patient who came with flank pain to emergency department to avoid misdiagnosis and treatment. In additon, it is to prevent any further deterioration.