Four people are on trial after a four-year-old girl was allegedly hit so hard in the stomach she nearly died and had to be admitted to hospital for emergency surgery.

The girl, from Tooting, was admitted to St George’s Hospital on Monday, March 25, 2013, suffering from serious injuries.

Ambulance staff described her as pale, mottled, cool and limp. That day she had been vomiting, wetting herself and had pain in her stomach, Kingston Crown Court heard this week.

Paramedics were called by her mother, who cannot be named for legal reasons, who was later arrested along with her ex-boyfriend, housemate and her housemate’s boyfriend.

Prosecutor Kate Lumsdon told the court on Tuesday, October 7, that during the course of that weekend the girl sustained an injury so serious it nearly killed her.

Doctors had to resuscitate her in hospital and carried out several hours of emergency surgery to find out what was wrong, cutting open her abdomen in the process.

At one point her surgeon told her mother it looked like they were going to lose the girl, at which the mother is described as sinking, screaming silently, the jury was told.

Ms Lumsdon said: “The Crown say that [the mother’s ex-boyfriend] was the perpetrator of this serious injury and other adults must have known and would have known what was going on and they did nothing to stop it.”

Medical professionals said her injuries were caused by a blow; by a fist, boot or foot, the court heard.

After she was admitted to hospital it emerged her two grandmothers had been concerned about other injuries the little girl had exhibited in the previous few months, it was claimed.

The court heard how family members had noticed bruises and cuts on the little girl. One of her grandmothers took photographs of the injuries as she grew more concerned, it was alleged.

The court heard that when the girl’s mother was asked about the earlier injuries she said she fell off her bicycle, had long nails and scratched herself and bruised easily.

Friends told police they noticed that when the mother’s ex-boyfriend was present, the little girl seemed withdrawn, quiet and acted scared.

At one point she even clung to the door frame when she had to leave her grandmother’s house, the jury was told.

The flat was lived in by the little girl, her mother and her mother’s friend. The ex-boyfriend and the housemate’s boyfriend stayed there at times and were brothers, the court heard.

The mother’s ex-boyfriend has been charged with grievous bodily harm with intent. All four defendants have been charged with causing or allowing the little girl to suffer physical harm.

At the beginning of questioning, done away from the courtroom, when asked what had happened to her tummy the girl said she had eaten too many sweeties. At times under questioning she said she did not know how she got hurt, and when asked if she remembered him hurting her she said “no”.

She was then cross examined by three lawyers. At times she told them it was Haribo sweeties that had made her tummy hurt and when asked if anybody hurt her she said “no”.

When asked directly if her mother’s boyfriend hurt her the girl replied “yes” and “he punched me”.

All four deny the charges. The trial continues.