Purpose:This study was undertaken to elucidate characteristic findings of tuberculous (TB) colitis at double‐contrast barium enema examination (DCBE).MATERIALS ANDMETHODS:Twenty‐five patients with TB colitis diagnosed by biopsy (n=13) or therapeutic trial (n=12) were included. DCBE findings were retrospectively analyzed, with special emphasis on distribution of lesions and mucosal changes.RESULTS:Involvement was asymmetric in 12. The lesion was noted more commonly in the ascending colon (n=23), cecum (n=21), and terminal ileum (n=19) compared with the transverse colon (n=15) and descending and sigmoid colon (n=9). Skipped lesions were seen in 13 patients. Sixteen patients had multiple ulcers that were mostly transverse or circumferential in alignment (n=11). Depth of ulcers was superficial (<2 mm) in 9 patients and deep in 13. Two patients had fistulas. Twelve patients had inflammatory polyposis. Three patients presented with mass, and misdiagnosis of malignant tumor was made in two. Thickening, deformity, and incompetence of the ileocecal valve were frequently noted (5, 6, and 8, respectively).CONCLUSION:DCBE revealed detailed mucosal changes of TB colitis. Ulcers aligned in transverse or circumferential pattern, involvement of the right side colon, and deformity of the ileocecal valve suggest diagnosis of TB colitis.