Splinting of the diaphragm due to air injections is not a reported entity.
Dr Evans claims that the infant succumbed owing to the deliberate injection of air into his stomach via a nasogastric (NG) tube. There is no reporting in the literature as to the possibility of such a claim. However, a central portion of the claim is that air forced into the stomach can build up to such an extent that it will splint the diaphragm, which would result in suffocation. This explanation is distinct from air embolism as a cause of death. Few articles can possibly support the claims made by Dr Evans. The one investigation that refers to pneumoperitoneum splinting of the diaphragm describes the circumstances in which gastric perforation occurs due to complications associated with oesophageal atresia (OA) and distal tracheo-oesophageal fistula (TOF) (see figure). The presentation of the infants is described as sudden, resulting in hypoxia and death. (Maoate et al.,1999). These findings are not applicable to Child C, as he did not have such conditions. Dr Evans repeatedly makes claims about the diaphragm being splinted by air in the abdominal cavity. However, in the absence of a perforation of the stomach or the development of pneumothorax, there is no way that simply pushing air through an NG tube would cause the diaphragm to splint. This claim appears to be totally hypothetical and without any empirical evidence demonstrating that such occurrences exist outside of Dr Evans' imagination. It was therefore not proper for this suggested cause of death to be put before the court. It is wholly unscientific.