The empty rectum on plain X-ray. Does it have any significance in the neonate?

The absence of rectal gas is said to be a sign of Hirschsprung's disease, especially when there is also gaseous distension of the bowel proximally. This paper reviews 136 neonates who had plain abdominal radiographs. There were 83 patients with multiple examinations, of which 52 (63%) showed variability in the presence of rectal gas on the radiographs. Fifty-seven of the total babies (42%) had significant bowel distension and of these 42 (74.5%) had absence of rectal gas. Only one of these cases had Hirschsprung's disease, most of the remaining having either generalized sepsis (42%) or necrotizing enterocolitis (25.5%).