Acute appendicitis is the most common surgically correctable cause of abdominal pain, the diagnosis of which remains difficult in many instances. Some of the signs and symptoms can be subtle to both the clinician and the patient and may not be present in all instances. Arriving at the correct diagnosis is essential; however, a delay may allow progression to perforation and significantly increased morbidity and mortality. Incorrectly diagnosing a patient with appendicitis although not catastrophic often subjects the patient to an unnecessary operation. The diagnosis of acute appendicitis is essentially clinical; however a decision to operate based on clinical suspicion alone can lead to removal of a normal appendix in 15–30 % cases. A number of clinical and laboratory based scoring system have been devised to assist diagnosis. The most commonly used is the Alvarado score and equally its modification,ultrasound abdomen, intraoperative and histopathological confirmation. Modified Alvarado score: This consist of three symptoms, three signs and two laboratory findings as described by Alvarado et al.