Hypopharyngeal perforation is a rare complication of endotracheal intubation. It most commonly occurs at the hands of the less experienced physician in emergency situations. The site most commonly perforated is the pharynx, posterior to the cricopharyngeal muscle; the second most common site is the piriform sinus. I report here a case of piriform sinus perforation secondary to intubation. Literature support is provided for the philosophy of early surgical intervention along with intravenous antibiotics as the treatment of choice.