Pyriform sinus perforation is a rare complication of endotracheal intubation. It most commonly occurs at the hands of the less experienced physician in emergency situations. It can occur after traumatic intubation and is potentially lethal. The site most commonly perforated is the pharynx, posterior to the cricopharyngeal muscle; the second most common site is the pyriform sinus. We report a case of pyriform sinus perforation after endotracheal intubation, which was successfully treated with primary closure.