Objectives: To evaluate the histopathological findings in appendectomy specimens and observe the negative appendectomy rate (NAR). Study Design: Observational study. Setting: Department of Surgery Unit III, Peoples University of Medical & Health Sciences, Nawabshah. Period: January to December 2018.  Material and Methods: 117 consecutive cases of appendectomy. All the demographic data and the clinicopathological details were recorded on a proforma designed for the study. The histopathological assessment was carried out in all cases. The ultrasound examination and CT scan was carried out in selected cases. The data collected was statistically analyzed and the results were tabulated. Results: During study period 117 appendectomies were performed. The mean age of patient was 27+9.4 years, majority of patients (53.8%) were females with female to male ratio of 1.2:1. The histopathological diagnosis was made in all cases and the results indicates that 105 cases having positive appendectomy and in 12 (10.3%) cases the appendix was found histologically normal. Among 105 positive cases, 97 (83%) were diagnosed as acute appendicitis, 2 (1.7%) cases show fibrous obliteration and 6 (5.1%) cases were having unusual pathologies. The cases having histological diagnosis of acute appendicitis includs acute mucosal appendicitis, acute suppurative appendicitis with or without periappendicitis and peritonitis, acute necrotizing appendicitis and perforated gangrenous appendicitis. The 6 cases of unusual pathologies includes 3 cases of granulomatous lesions and one case each of carcinoid tumor, mucinous cystadenoma and worm infestation. The ultrasound was performed in 48 (41%) patients out of them 30 cases had positive findings on ultrasound examination were confirmed on histological examination and all 5 positive cases that were reported on CT scan were confirmed on histopathological examination. Conclusion: High rates of negative appendectomy in the female sex were observed, that can be reduced by the use of diagnostic imaging modalities specially ultrasound. The findings of abnormal pathologies on histopathological examination of the appendix suggest that histopathological analysis is necessary in all of the resected specimens.