A 16 year old girl presents to the emergency department with a chief complaint of abdominal discomfort. She states that is started approximately 15 hours ago and was mainly localized to the mid-abdomen. It is associated with nausea and vomiting and she has no desire to eat. The pain has become progressively worse and is now mainly localized to the right lower quadrant. On physical exam, the young woman appears ill, but non-toxic. It hurts in his right lower quadrant upon palpation, and hurts on the right when palpating the left lower quadrant. Her white blood count is 13,000. The next step in the management of this patient should be:

A. Observe the patient in the emergency department until the abdomen becomes rigid.

B. Perform a colonoscopy.

C. Send the patient home with instructions to return in 24 hours if not feeling better.

D. Obtain a CT scan to confirm the clinical suspicion.

E. Admit the patient, order NPO status, start intravenous (IV) infusion. Postpone surgery until the WBC is greater than 16,000 or his abdomen becomes rigid

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