Background: Appendicitis even though being the most common cause of surgical abdomen, its diagnosis remains an enigmatic challenge. Aim: This study aims to prove whether the clinical, investigative and operative findings correlate with histopathological findings of both acute and chronic forms of appendicitis. Materials and Methods: The study was conducted on 64 patients admitted in P K Das Institute of Medical Sciences, diagnosed of having appendicitis and underwent appendectomy during period of 18 months from July 2018 to December 2019. Results 64% of cases were seen in age group 10-30 years  Rate of appendicular perforation was 7.8%  Significant association was found between clinical findings (previous history of pain abdomen) and histopathological findings of chronic inflammation of appendix.  Sensitivity of clinical judgment and ultrasonogram to diagnose appendicitis was found to be 93.6% and 80.9% respectively.  Sensitivity of operative findings to detect appendicitis was only 58.7%. Negative predictive value of operative findings to identify appendicitis was only 3.7%. Conclusion:The diagnostic accuracy of the surgeon is directly dependent on the surgeon's expertise and there is no substitution for an experienced surgeon's judgment. Ultrasonography is a useful tool in avoiding negative appendectomy rates particularly in females and should be used in cases with equivocal clinical findings. Ultrasonography has limitation of variable reliability and operator dependency. If surgeon encounters a normal looking appendix per-operatively in a clinically diagnosed case of appendicitis still appendectomy should be done.

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