Background: Diagnosis of appendicitis continues to be an issue in surgeon’s lives. Despite the wide availability diagnostic methods, clinical dilemma persists. An ideal diagnostic tool helps avoid unnecessary surgeries without missing on potential complications. Methods: Current study evaluates the efficacy of Modified Alvarado Scoring System along with ultrasonography as a pre–operative diagnostic tool in acute appendicitis, in correlation with operative and histopathological findings. Results: Out of the 50 cases the 66% males predominated over 33% females. Histopathological examination with Ultrasonogram made in patients with ≥7 and <7 Alvarado score is useful in identifying the missed–out cases thereby preventing diagnostic delay. By this 36 patients are positive out of 50 in this study. Conclusions: By this study, we conclude that in beginning the diagnosis in patients suspected of having acute appendicitis, histopathological methods is better compared to USG and Alvarado scoring system. All the three methods were used for diagnosis of acute appendicitis diagnostic accuracy.