Background Testicular tumor is one of the common solid tumors in young men. Testicular choriocarcinoma is a non-spermatogonial germ cell tumor, which is the rarest of all testicular cancers. Choriocarcinoma usually shows bleeding at the metastatic site, while gastrointestinal involvement is rare. Methods Here, we report a case of testicular choriocarcinoma with gastrointestinal bleeding as the first diagnosis and summarize the similar cases all over the world in recent 20 years. Results A 28-year-old male was treated with repeated melena for 2 months. No bleeding foci of the stomach, duodenum, colon, and rectum were found in endoscopy, and no bleeding foci of digestive tract was found in selective angiography, but a space occupying lesions of the lung, liver, and upper jejunum were found in chest and abdominal CT. Considering the possibility of a metastatic tumor and the ineffectiveness of medical treatment, the patient was converted to surgical treatment. The postoperative pathology was consistent with testicular choriocarcinoma. The patient received a chemotherapy regimen of paclitaxel, ifosfamide, and cisplatin. At present, the chemotherapy regimen is well tolerated. Conclusions The case report confirmed that even if we cannot find the logical relationship between clinical manifestations and genital examination, genital examination should also be part of the patient’s systematic examination.

Background: Testicular tumor is one of the common solid tumors in young men. Testicular choriocarcinoma is a non spermatogonial germ cell tumor, which is the most rare of all testicular cancers. Choriocarcinoma usually shows bleeding at the metastatic site, while gastrointestinal involvement is rare. Methods: Here we report a case of testicular choriocarcinoma with gastrointestinal bleeding as the first diagnosis, and summarize the similar cases all over the world in recent 20 years.Results: A 28 year old male was treated with repeated black stools for 2 months. No bleeding foci of stomach, duodenum, colon and rectum were found in endoscopy, and no bleeding foci of digestive tract were found in selective angiography, but space occupying lesions of lung, liver and upper jejunum were found in chest and abdominal CT, Considering the possibility of metastatic tumor and the ineffectiveness of medical treatment, the patient was converted to surgical treatment. The postoperative pathology was consistent with testicular choriocarcinoma. The patient received a chemotherapy regimen of paclitaxel, ifosfamide and cisplatin. At present, the chemotherapy regimen is well tolerated. Conclusions: The case report confirmed that even if we can't find the logical relationship between clinical manifestations and genital examination, genital examination should also be part of the patient's systematic examination.