Hypopharyngeal perforation is a rare, but fatal, complication. Clinical signs and symptoms of this condition are neck pain, odynophagia, dysphagia, fever, vomiting, cervical swelling and subcutaneous emphysema. However, these signs are obscured in patient suffering from severe trauma who has had an endotracheal tube inserted, which delay proper evaluation and treatment. Here, we report a case of hypopharyngeal perforation in a trauma patient who had an endotracheal tube inserted for mechanical ventilation.