INTRODUCTION: Metastatic testicular embryonal carcinoma presenting as gastrointestinal hemorrhage is an uncommon phenomenon. While testicular cancer is the most common malignancy in males 20–35 years of age, metastases to the gastrointestinal tract occur at an incidence of less than 5%. In a young man with otherwise unexplained gastrointestinal hemorrhage, it is important to consider the possibility of underlying malignancy. CASE DESCRIPTION/METHODS: A previously healthy 27-year-old male presented with two weeks of abdominal pain and three days of melena and hematemesis. He was found to be in hemorrhagic shock with a hemoglobin of 5.3 and resuscitated aggressively with blood products and fluids. A CT abdomen/pelvis showed a large 15.1 cm × 13.9 cm × 8.6 cm hypervascular soft tissue mass with a necrotic center and multiple foci of contrast blush located adjacent to the third portion of the duodenum, extensive peritoneal and retroperitoneal lymphadenopathy, and multiple lung masses (Figure 1). Esophagogastroduodenoscopy (EGD) revealed an exophytic mass-like obstruction in the duodenum that when traversed, revealed a large cavity filled with necrotic tissue and old blood extending from the third portion of the duodenum deep into the subperitoneal space (Figure 2) with slow hemorrhage from friable tissue treated with coagulation graspers. The patient's clinical course was complicated by multiple episodes of recurrent hemorrhage requiring repeat endoscopic treatment with bipolar coagulation, epinephrine injection, and hemostatic powder application. A diagnosis of germ cell tumor was made based on scrotal US showing multiple masses and a significantly elevated beta-HCG. He was treated with chemotherapy with subsequent decrease in the size of his abdominal mass and resolution of bleeding. DISCUSSION: Testicular cancer is the most common malignancy in males 20–35 years of age, usually presenting with painless scrotal swelling. Metastases can involve retroperitoneal lymph nodes, which drain the testes. Gastrointestinal metastases are rare, and metastatic disease may not initially be considered in a young male presenting with gastrointestinal hemorrhage. This case demonstrates the importance of testicular imaging and exam should there be concern for underlying malignancy, especially if other causes of gastrointestinal hemorrhage have been ruled out. Early diagnosis and intervention may often lead to improved clinical outcomes.Figure 1.: CT abdomen showing a large heterogeneously enhancing hypervascular soft tissue mass which appears to be contiguous with the third part of the duodenum. Large necrotic central component present.Figure 2.: EGD showing duodenal lumen immediately proximal to the cavity. Note the adherent clot at the top of the abnormal tissue directly in front.Figure 3.: Necrotic cavity in duodenum.