FAP and neoplasm: Surgical trauma is a well-established trigger for FAP-associated desmoids, with most developing at prior surgical sites within 5 years of an operation.13,14) An aggressive, wide-margin resection itself constitutes significant surgical trauma, which may paradoxically trigger a “second hit” and promote new tumor growth or recurrence.13) The progressive growth of the tumor in our patient is likely attributable to his extensive history of major abdominal surgeries, including a subtotal colectomy and, in particular, a partial duodenal resection.