Background: Renal rupture and retroperitoneal abscess formation after extracorporeal shock wave lithotripsy (SWL) is a rare and potentially life-threatening complication if left untreated with a high morbidity rate. In this study, we present a rare case of renal rupture after SWL, with formation of an extensive retroperitoneal abscess extending to the left abdominal and lumbar area. Case Presentation: A 48-year-old Caucasian woman presented to the outpatient department with left abdominal and lumbar redness and swelling caused by renal rupture and massive perinephric abscess formation, 10 days after SWL treatment of her left renal pelvic stones. She was treated first with drainage of the retroperitoneal abscess and simultaneous Double-J stent placement in her left kidney. A left open nephrectomy was subsequently performed because of persistence of kidney infection. Conclusion: Retroperitoneal abscess formation after SWL is a serious and highly morbid complication, which should be early diagnosed and timely treated.