D Terminal ileum
Even though the patients presentation was consistent with appendicitis, finding a normal appendix should not end the search. Running the small bowel is necessary to rule out a Meckel's diverticula or evidence of terminal ileitis. Closing the abdomen and observing or starting steroids would only cause more harm. A right hemicolectomy is not indicated in this situation.
The most common complication from Meckel's diverticulum is bleeding secondary to ulceration of the heterotopic gastric tissue. It is the most commonly encountered diverticulum of the small intestines and represents a true diverticulum. It is the direct result of persistence of the omphalomesenteric duct. Technetium scans can be used to identify diverticula with heterotopic gastric tissue. acute diverticulitis although not the most common presentation can mimic acute appendicitis clinically . There is much controversy about the treatment of an incidentally found Meckel's diverticulum. The general principles are that it should be removed if there is evidence of heterotopic tissue and/or there is a narrowed neck. Other relative indications include unexplained abdominal symptoms and evidence of prior inflammation. The location on the antimesenteric border is normal and is not an indication for surgical resection. The most common location of a Meckel's is the terminal ileum usually located 45-90 cm. from the ileocecal valve.