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a) Diagnostic laparoscopy
b) Repeat CT scan of the abdomen and pelvis
c) Exploratory laparotomy
d) Ultrasound of the right lower quadrant
e) Don't Know

2. A repeat CT scan of the abdomen and pelvis is obtained.

What is the differential diagnosis?

a) Perforated appendicitis with abscess
b) Perforated Meckel's diverticulum with abscess
c) Inflammatory bowel disease with perforation and abscess
d) All of the above
e) Don't Know

3. What additional studies may be helpful before further intervention? (Give all correct answers)

a) Abdominal ultrasound
b) Barium enema
c) Upper GI with small bowel follow-through
d) Colonoscopy with biopsy of terminal ileum

4. After adequate bowel prep, a colonoscopy with ileal biopsy was performed and no pathology was identified. An upper GI with small bowel follow-through revealed a 3 cm gas collection in the right lower quadrant (proximal to the ileo-cecal valve) which filled with contrast when the patient was placed in the lateral decubitus position. Which of the following diagnoses would explain the findings?

a) Perforated duodenal ulcer
b) Crohn's disease
c) Meckel's diverticulitis
d) Perforated appendicitis
e) Don't Know

5. What is the next step? (Give all correct answers)

a) Percutaneous drainage of the intra-abdominal collection
b) Exploratory laparotomy
c) Laparoscopy
d) Intravenous antibiotics and interval appendectomy