Background: Acute appendicitis is a common surgical emergency, and timely diagnosis is crucial to prevent complications. The Alvarado scoring system is a widely used clinical tool designed to aid in the diagnosis and management of suspected cases. Objectives: To assess the clinical presentation of acute appendicitis and evaluate the diagnostic accuracy of the Alvarado scoring system in correlation with histopathological findings. Methods: A prospective observational study was conducted on 75 patients presenting with symptoms suggestive of acute appendicitis. Clinical evaluation, Alvarado scoring, imaging studies, and surgical outcomes were recorded. The correlation between Alvarado score and histopathology was statistically analyzed using the chi-square test. Diagnostic parameters including sensitivity, specificity, predictive values, and overall accuracy were calculated. Results: The majority of patients were males (60%) and aged between 31–40 years. Surgery was performed in 82.7% of cases. A significant association was observed between Alvarado score and histopathological findings (p = 0.03). An Alvarado score >7 showed a sensitivity of 69.35%, specificity of 61.54%, and a high positive predictive value of 89.58%, with an overall diagnostic accuracy of 68%. Wound infection was the most common complication (24%), while 69.3% had no postoperative issues. Conclusion: The Alvarado scoring system is a valuable, simple, and cost-effective tool in diagnosing acute appendicitis. It has high diagnostic utility when the score is >7 but limited ability to rule out the disease when the score is low. Combined with clinical assessment, it can enhance decision-making and improve outcomes.