Laparoscopic operations are generally safe procedures. Complications of carbon dioxide (CO2) insufflation are rare but can be life threatening. That’s why it is very important for whoever handling this type of patients to be familiar with those complications and consequences. We are presenting a 61 year old woman who underwent laparoscopic repair of umbilical hernia. Surgery was uneventful; patient discharged home next day. Eight days later patient presented with generalized subcutaneous emphysema, started on the third postoperative day. CT scan showed extensive, generalized, subcutaneous emphysema with pneumomediastinum and penumoperitoneum. Laparotomy showed perforation at cecum, with gross faecal contamination of peritoneal cavity, right hemicolectomy with double barrel stoma performed. Colonic perforation may be due to thermal iatrogenic injury during surgery predisposed by presence of adhesions and diseased bowels as confirmed by histpathologic examination. We concluded that long operative time, higher CO2 pressure, more surgical ports and older age can be predisposing factors for this rare of presentation for colonic perforation.

Background: Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC isfast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental andgenetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC. Materials and Methods: Retrospective case review study done on CRC patients at Universiti Kebangsaan Malaysia MedicalCentre (UKMMC), Kuala Lumpur, Malaysia. Patients’ socio-demographic characteristics, modalities oftreatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records. Results:A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%).Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms includingper rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was13 weeks (IQR 21.8). More than two-thirds presented as non-emergency cases (69.2%). Most patients presentedwith Dukes C stage(40.2%). The overall 5-year survival rate was 40% with local recurrence rate of 19.6%.Metastasis after curative-intend treatment (surgery with adjuvant therapy) developed in 26% of patients. Lowerrecurrence (p = 0.016, OR = 0.205) and metastatic disease (p = 0.02, OR = 0.24) found among the Chinesepatients. Almost half of the patients defaulted follow up care (43%), most often within the first year of treatment(22.4%) and the Chinese were the least likely to default (p= 0.04, OR = 0.45). Conclusion: Socio-demographicprofile of CRC patients in UKMMC is comparable to Asia pacific region. Apparent delay in seeking treatmentgives rise to poor overall survival and local recurrence rates.

Background: Patients' delay in the presentation with rectal bleeding had been identified as a factor for late diagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting a medical practitioner and identifying associated factors. Materials and Methods: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaire included data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any self treatment prior to medical consultation and patients' opinion on causes of their own rectal bleeding. Results: The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6; 95% CI 3.3-27.5), who did not seek anyone's advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment before seeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logistic regression revealed that less worry of rectal bleeding and not seeking anyone's advice were important predictors (p < 0.05). The majority of patients attributed their bleeding to benign causes. Conclusion: A high proportion of patients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needs to focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.

Background: Knowledge is believed to be a driving factor for patients’ early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation. Methods: A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer. Results: Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help. Conclusion: Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients’ help seeking behavior other than knowledge. Keywords : rectal bleeding delay in seeking help Knowledge colorectal cancer Malaysia