A young man nearly lost his life to a toothpick he didn’t even know he had swallowed, according to a harrowing report published Wednesday in The New England Journal of Medicine.

The three-inch wood pick, from a sandwich, traveled through most of his digestive tract without doing any harm. But then it poked through the intestinal wall and pierced an artery, creating a conduit for bacteria to invade his bloodstream and damaging the artery enough to cause serious bleeding.

For nearly three weeks, his symptoms — abdominal pain, fever, distressing gut trouble — mystified doctors. By the time they figured out what was wrong, he had a potentially fatal infection. It took extensive surgery to save him.

Injuries like this are not common, but cases have been reported in medical journals over the years.

Toothpicks are everywhere, jabbed into sliders, wraps, club sandwiches and cocktail garnishes. Often, people have no idea they swallowed one, maybe because they were distracted or eating in a hurry.