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Uncommon lesions of the caecum are of interest because of the diagnostic and therapeutic difficulties associated with them. This paper presents the case reports of three patients with such a lesion. The pathology found was typical of that seen in the condition formerly described as “non‐specific ulceration of the caecum”, but the additional finding of micro‐circulatory thrombosis suggests the probable pathogenesis and leads to a new concept of the lesion, thus allowing a more definitive name to be applied to it. A review of the literature is presented, the natural history discussed, and a plan of management formulated. Because of the similarity of the clinical features to those of acute appendicitis, the correct diagnosis is rarely made before operation, but even at operation differentiation from more serious pathology may be difficult. The treatment of choice is immediate wide resection.

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Summary: Haematological studies were performed in thirteen patients with acute respiratory failure secondary to trauma (10 cases), or other causes in which clinical features suggesting disseminated intravascular coagulation were present including shock, haemorrhagic manifestations and central nervous system, renal, endocrine and hepatic dysfunction. In the four fatal cases features of intravascular clotting shown at autopsy included focal haemorrhages, thrombi and infarcts. Thrombocytopenia, decreased factor II levels and elevated fibrin split products were observed in all patients. Levels of other coagulation factors varied but serial changes followed a pattern characteristic of disseminated intravascular coagulation. Ten patients had low levels of plasminogen initially. Serial thrombin times were not greatly prolonged and euglobulin lysis times were lengthened. Red cell fragmentation and progressive anaemia in all cases, combined with either a decrease in haptoglobin or a rise in plasma haemoglobin in nine patients, provided evidence of microangiopathic haemolysis. β1A‐globulin (C'3) was sub‐normal in nine of twelve patients studied. These data demonstrate disseminated intravascular coagulation leading to secondary fibrinolysis, microangiopathic haemolysis and, apparently, complement activation. In the light of both clinical and experimental observations, disseminated intravascular coagulation is an important pathogenic mechanism in acute respiratory failure of diverse aetiologies, and explains many of its features.