Pyriform sinus perforation secondary to traumatic intubation in a difficult airway patient

Pyriform sinus perforation is a relatively rare complication of endotracheal intubation in anesthesia. It can occur after traumatic intubation and is potentially lethal. We recently encountered a patient who developed perforation of the left pyriform sinus when intubation was performed emergently by an inexperienced person in a difficult situation outside the operating room. Clinical manifestations and implications of this complication are discussed.