Introduction: Acute appendicitis is one of the most frequent causes of abdominal pain in patients presenting to the emergency department (ED) who need surgical treatment with an incidence of 100 to 200 cases per 100,000 person-years. In this study, we have decided to see the incidence, clinical features and complications associated with appendicolith associated acute appendicitis in the patients which presented to us with clinical features of acute appendicitis in our tertiary care hospital setup Objective: To study the incidence, clinical features and complications associated with appendicolith associated acute appendicitis in the patients which presented to us with clinical features of acute appendicitis in our tertiary care hospital (IMS __ampersandsignamp; SUM Hospital). Methods: This is a prospective study, carried out in IMS __ampersandsignamp; SUM Hospital, a tertiary care hospital, Odisha during the period between April 2019 to October 2020. All the patients presenting to the Emergency Department (ED) with symptoms suggestive of Acute Appendicitis were included in this study. Results: Of the 200 patients who underwent appendectomy, 63 (31.5%) patients were __ampersandsignle; 17 years of age. Following appendicectomy, appendicoliths were found in 66 (33%) appendicectomy specimens. The sensitivity of trans abdominal ultrasonography to detect appendicolith to be 53.03% with a positive predictive value and specificity to be 67.30% and 87.31% respectively. Overall, complicated appendicitis was more commonly seen in patients with appendicolith as compared to patients without appendicolith (69.7% vs 23.9%), and this value is significant (P __ampersandsignlt; 0.001). Conclusion: Acute appendicitis is more common in the pediatric age group (0-17 years) as compared to the adult population. Ultrasonography has very low sensitivity and is a poor predictor of appendicoliths in patients presenting with acute appendicitis. Appendicitis with appendicolith results in higher incidences of complicated appendicitis. Thus, these patients should undergo appendicectomy rather than conservative management