Abstract : Acute appendicitis is one of the commonest causes of acute abdomen. The signs and symptoms differ to a great extent and even though the diagnosis is essentially clinical, ultrasound is essential in diagnosing abnormal positions and for pregnant women presenting with acute appendicitis. This present observational cross-sectional study was conducted at Dr. D. Y. Patil Medical college, hospital & Research Centre as an attempt to easing the diagnosis of acute appendicitis. Majority of the patients (36.36%) belonged to the age group of 18-25 years. There were 46.36% male patients while female patients constituted 53.64% of the study group. The most common site of pain was right iliac fossa (61.82%). In our study, the most common position of appendix Intra-Operatively was retrocecal (78.18%) of cases. In our study, on comparison between the ultrasound position and intraoperative position of appendix, the USG had a sensitivity of 100% in paracecal, preileal and subhepatic positions of appendix, 88.9% sensitivity in postileal position, 74% sensitivity in retrocecal position of appendix and 66.7% sensitivity in pelvic position of appendix. On comparison of ultrasound findings and pre-operative clinical findings and intra-operative findings, ultrasound diagnosed appendicitis whether complicated or uncomplicated in 86 cases (78.18 %) whereas gave a normal report in 24 cases (21.81%). We conclude that the accurate localization of position of appendix requires an amalgamation of all modalities namely clinical examination, ultrasonography and intra-operative findings and not just one isolated modality, thereby reducing the complications associated with a missed diagnosis as well as avoiding unnecessary surgery in false positive cases ultimately reducing morbidity associated with this very much treatable condition.