INTRODUCTION: Endoscopic Retrograde Cholangiopancreatography (ERCP) had become the favored method to access the pancreaticobiliary system because its a safer less invasive method compared to surgery. However, as with any procedure ERCP comes with its own risks and potential complications. We present a unique case of patient who underwent and ERCP and developed necrotizing infection of neck and a submandibular abscess. CASE DESCRIPTION/METHODS: Patient is a 66-year-old female who presented to an outside hospital with complaint of right upper quadrant abdominal pain, workup revealed choledocholithiasis. ERCP was attempted however cannulation was unsuccessful. The patient was discharged home after the procedure, but within 48 hours she presented to our institution complaining of left sided neck pain, dysphagia, and drooling. Computed tomography of the neck revealed extensive gas and fluid collections at the left submandibular space. Patient was taken to the operating room for drainage of left deep neck abscess. Drainage and irrigation of the abscess yielded streptococcus mitis. Rest of patient’s hospital course was uncomplicated and patient was discharged with appropriate follow up. DISCUSSION: ERPC is a challenging gastrointestinal endoscopic procedures. Adequate volume of procedures is required to maintain proficiency and avoid complications. Uncommon complications such as perforation are reported in <1% of case. Perforations are most commonly reported in the esophagus, stomach, duodenum, periampullary region, and bile ducts. In the case of our patient, ERCP was complicated by a perforations of the hypopharynx. The most frequent cause of pharyngeal perforation is iatrogenic due to instrumentation commonly due to the advancement of the endoscope or endotracheal tube (ETT). Pharyngeal perforation can be subclassified into supraglottic and infraglottic. The latter is more commonly associated with advancement of an ETT during intubation and presents with blood in the ETT or decreased end tidal CO2 or decreased tidal volume. Advancement of endoscope in an already intubated patient can lead to a supraglottic tear which can present with bleeding observed outside of the ETT. Patients with supraglottic or infraglottic perforations can present with similar clinical symptoms of dysphagia, fevers, oral bleeding, subcutaneous emphysema of the neck. Quick identification and treatment can decrease the morbidity and mortality in such patients.