Premature infants are particularly at risk of iatrogenic pharyngoesophageal perforation. It is a rare occurrence but when it does occur it often mimics esophageal atresia. We presented a case of a term neonate who presented with a hypopharyngeal perforation that resulted during ritual procedure (Ghaanti) done by grandmother. Clinical findings, a plain chest xray, an esophagography and endoscopy are helpful. Surgery can be avoided in most instances.