Background: Acute appendicitis is one of the most common surgical emergencies worldwide. Early diagnosis and intervention are essential to reduce complications such as perforation and peritonitis. Clinical evaluation remains a cornerstone in diagnosis, particularly in resource-limited settings where advanced imaging is not always accessible.

Objectives: To evaluate the clinical profile, laboratory parameters, and intraoperative findings of patients diagnosed with acute appendicitis in a tertiary care hospital in North India.

Methods: This prospective observational study was conducted over one year and included 100 patients who presented with signs and symptoms suggestive of acute appendicitis and subsequently underwent appendectomy. Clinical history, abdominal examination, total leukocyte count (TLC), intraoperative findings, and histopathological confirmation were recorded and analyzed.

Results: The study population had an equal gender distribution (50% male, 50% female), with a mean age of 30.48 ± 16.8 years. The most affected age group was 11–30 years. Right iliac fossa pain was reported by all patients, while 96% reported progression and 92% relocation of pain. Rebound tenderness was observed in 85%, and rigidity in 47%. TLC was >14,000 in 21% of patients, all of whom had confirmed appendicitis. Even among those with TLC <9,000, 80.55% were histopathologically positive. The duration of pain before presentation did not significantly alter diagnostic accuracy.

Conclusion: Acute appendicitis predominantly affects young adults and presents consistent classical symptoms. Rebound tenderness and elevated TLC are valuable diagnostic indicators. However, normal TLC does not exclude the diagnosis, reaffirming the importance of thorough clinical evaluation in guiding timely management.