Background: Acute appendicitis is a common surgical emergency, with diagnostic challenges due to its varied presentations. Accurate diagnosis is crucial for effective management. This study compared the diagnostic accuracy of the RIPASA score and ultrasound in acute appendicitis cases.Methods: A cross-sectional analysis was conducted involving 100 patients with symptoms suggestive of acute appendicitis. The RIPASA score and ultrasound were evaluated against histopathological examination (HPE), which served as the gold standard.Results: The RIPASA score identified acute appendicitis in 73% of patients, with a PPV of 89% and an NPV of 44%. Ultrasound identified appendicitis in 68% of patients, with a PPV of 86.8% and an NPV of 34.4%. The integration of both diagnostic tools suggested potential enhancements in overall diagnostic accuracy. Conclusion: Both the RIPASA score and ultrasound are effective diagnostic tools for acute appendicitis. However, the RIPASA score showed a slightly better PPV, and when combined with ultrasound, could offer a more robust diagnostic approach, particularly beneficial in resource-limited settings.