Background: The illness process of appendicitis is defined as dynamic and lasts between 24 and 36 hours. Basically, a patient's medical history and clinical examination are a cornerstone for acute appendicitis diagnosis. Objectives: The present study aimed to compare the diagnostic utility of abdominal ultrasound and the Modified Alvarado scoring approach with a postoperative histological analysis in the diagnosis of acute appendicitis. Methods: In this study, 193 patients complaining of acute abdomen pain suspected of acute appendicitis were prospectively recruited. The study population was divided into two groups regarding the Modified Alvarado scoring ≥ 7 and > 7. Results: Our analysis indicated overall specificity, sensitivity and accuracy of diagnosis of the Modified Alvarado score were 81%, 67.7%, and 72% chronologically. While specificity and sensitivity of pelvic pelvi-abdominal ultrasonography were 71.4% and 86.2% respectively. Conclusion: When the Alvarado score is high (> 7), there are strong indicators that the patient is experiencing right lower quadrant abdomen discomfort. The Alvarado score approach is a low-cost, dependable, and reproducible diagnostic approach that may be utilised by both primary care physicians and emergency room doctors.