Adverse respiratory events during endotracheal intubation for general anesthesia are variable. These events frequently occur to difficult airway patients. Traumatic endotracheal intubation with poor glottic exposure and blind thrust can perforate the hypopharynx or cervical esophagus. We experienced a case of esophageal perforation during endotracheal intubation for general anesthesia of total hip replacement in a 50 year old female patient. Neck extension was almost impossible due to longstanding ankylosing rheumatoid cervical arthritis. We tried several times of endotracheal intubation but failed. Post-operative esophago-graphy after we found subcutaneous emphysema confirmed esophageal perforation. Emergency tube drainage and general supportive care were done. Fortunately she recovered uneventfully and discharged on post-op. 30th days.