Ischemic orchitis is an established complication after open and laparoscopic inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the surgical approach is very rare. We reported a case of healthy 47 year-old man, with no previous surgery or history of trauma, who presented with right direct inguinal hernia. He is a thin, muscular male with a narrow pelvis who underwent right extraperitoneal mesh implantation with open inguinal hernia repair. The patient was discharged on the same day and doing well with minimal pain and swelling until the fifth day after surgery. That night he presented with sudden-onset of pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Scintigraphy and ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy.