Teenager with epigastric pain and lower abdominal pain AP spot image of the duodenum from an UGI exam shows a target sign with barium pooling centrally in a large ulceration surrounded by an edematous ring in the distal aspect of the duodenal bulb. There was also extensive inflammation of the terminal ileum shown later on the small bowel followthrough exam. The diagnosis was a duodenal ulcer due to Crohn disease.