A pathologist has told a court that blunt force trauma is “the only plausible explanation” for the injury that caused the death of a 10-month-old baby whose mother and stepfather are accused of his murder.

Jacob Crouch collapsed on December 30 2020 and was later found to have at least 39 rib fractures and 19 visible bruises, as well as a tear in his bowel which led to peritonitis – an infection of the lining of the abdominal organs – and his eventual death.

Gemma Barton, 33, and Craig Crouch, 39, deny murder and other child cruelty offences.

All of the natural disease processes that can end up with a bowel perforation, we have excluded all of these, which leaves the only likely explanation being trauma

Prosecutors have previously told a trial at Derby Crown Court that Jacob died from a “vicious assault” which saw him “kicked or stamped on with such severe force that it fractured a rib and caused a tear in his stomach and bowel”.

Giving evidence on Thursday, forensic pathologist Dr Michael Biggs said trauma was the only medical explanation for the bowel tear, an injury he would expect to see in car crash victims or those who had suffered a multi-storey fall.

He said: “We have ruled out all of the usual suspects in terms of natural diseases.

“All of the natural disease processes that can end up with a bowel perforation, we have excluded all of these, which leaves the only likely explanation being trauma.

“It is really the only plausible explanation as to why this bowel perforated.”

Jacob was found dead in his cot at his home in Foxley Chase, Linton, Derbyshire, with Crouch and Barton arrested on January 5 2021.

Texts between the pair showed that they at one point referred to him as the “devil”, fed him his own vomit, talked about bathing him in bleach and would send him to bed or smack him for “crying for no reason”, jurors were told.

In June 2020, Crouch told Barton that she needed to be “more regimental” with the youngster to “not let this take over us”, the court heard.

This, prosecutors said at the start of the trial, fuelled a “culture of cruelty” which saw Jacob assaulted “on a regular basis” over six months.

If these sorts of injuries could occur during normal play, we would see a lot more of them. We tend to see these sorts of injuries in more extreme forms of trauma. I would not be surprised to see a bowel perforation in something like a car crash

Jacob’s medical cause of death was later confirmed as peritonitis caused by a traumatic bowel perforation, following a post-mortem examination performed by Dr Biggs.

On Thursday, the jury was shown body maps of the youngster’s ribcage indicating a series of fractures, sustained between more than six weeks and up to two hours before he died.

Barton, wearing a green dress and white cardigan, has cut off most of her hair since the start of the trial and wept throughout Dr Biggs’s evidence, while Crouch, in a blue shirt and grey waistcoat and trousers, remained silent.

Under cross-examination from Barton’s defence lawyer, Clive Stockwell KC, Dr Biggs said the multiple bruises and rib fractures were “positive evidence” of trauma and it was the only “pathologically valid” explanation for Jacob’s death.

While he could not tell what form the trauma took, Dr Biggs said that he would expect to see such an injury from a “sharp, sudden application of force” such as a punch or kick.

He also could not determine when it had happened, but told the jury that bowel perforations would cause inflammation and infection which could cause a body to shut down within hours and, at most, “a small number of days”.

Symptoms would include lethargy, vomiting and a refusal to eat, and Jacob would have been “systematically unwell” before his death.

Answering questions from prosecutor Mary Prior KC, Dr Biggs said the amount of force needed to cause such an injury would be “over and above” those seen in normal child’s play, adding: “There are lots of toddlers out there playing and falling over all the time.

“If these sorts of injuries could occur during normal play, we would see a lot more of them.

“We tend to see these sorts of injuries in more extreme forms of trauma.

“I would not be surprised to see a bowel perforation in something like a car crash.”

Mrs Prior said: “So the multiple bruises and multiple rib fractures suggest multiple instances of trauma on multiple occasions?”

“Yes, that’s correct,” Dr Biggs replied, adding they were “suggestive of non-accidental injuries”.

Barton, of Ray Street, Heanor, Derbyshire, and Crouch, of Donisthorpe Lane, Moira, Swadlincote, both deny murder, causing or allowing the death of a child, causing a child to suffer serious physical harm and three counts of child cruelty.

The trial continues.