When the appendix looks normal, look for another cause. In particular, check the distal ileum for a Meckel's diverticulitis, which mimics appendicitis exactly and is found only at exploration. Most surgeons then also remove the appendix, especially in young patients, so the diagnosis is not confused later. Leaving the appendix in place (C) is a recognised alternative, because the textbook says there is no consensus on removing a normal appendix. Not examining the ileum (B, D) is wrong in either case.