As a surgeon Acute Appendicitis has always given me a challenge, whether it is in the diagnosis or in the management. The varied presentations and the close proximity to different pathologies make acute appendicitis one of the most challenging acute surgical conditions. This piece of research extensively gives insight about the epidemiological aspects, surgical anatomy, pathophysiology, clinical examinations, investigation protocols and surgical managements. I have also included extensive review of literature of related topics. RIPASA is a newly developed clinicopathological scoring system which can effectively guide us in these clinical scenarios. A new diagnostic pathway centered around RIPASA scoring system has been formulated and presented in this book. I firmly believe that my efforts would be a stepping stone for all acute surgeons.