Holiday worker Chelsea Hyndman, 20, died in Crete on May 17, 2010 from severe abdominal injuries and her partner, Luke Walker, was eventually found guilty last year of GBH which led to her death.
But giving evidence on the first day of the inquest into her death in Wakefield, Professor Colin Johnson - a consultant surgeon and a specialist on the pancreas - said a fall while out drinking with friends 11 days before her death may have triggered her deteriorating health.
Witnesses claimed Chelsea had a bottle in one hand while her left hand was in her belt as she adjusted her clothing, and so fell straight “like a plank” without putting her hands out in front of her.
Prof Johnson claimed that her left fist caught in her belt could have been enough to cause the damage to her pancreas, which eventually led to the acute peritonitis and caused multiple organ failure.
He said: “In the case of someone who is drunk and the abdominal muscles relaxing, falling on the fist is sufficient to suppress the pancreas and cause the injury.
“Falling in the way described is sufficient.”
This was also supported by Dr Alan Anscombe, a forensic pathologist who also gave evidence and agreed that the injury could have been caused by the fall, but only if a protruding object was sticking up and had connected with the abdominal area, possibly an object like a clenched fist.
Chelsea was admitted to hospital on May 16, 2010 with severe stomach pains and she had become jaundiced.
Despite emergency surgery, she died the next day.
Her long-term boyfriend, Luke Walker, from Brierley Hill in the West Midlands and with whom she was sharing an apartment, was initially charged with the murder of Chelsea after medical reports suggested her injuries were caused by blunt trauma, consistent with being kicked or stamped on.
But during a trial in May 2013 the charge was reduced to grievous bodily harm leading to Chelsea’s death.
And he was eventually given a three-year suspended sentence by a court in Crete.
Asked by the area coroner, Jonathan Leach, if he thought it was more likely the fall or an assault, Prof Johnson said: “I do not think with the state of the injuries it’s really possible to say one way or another.
“If there was an assault, it could have exacerbated things, however there were clinical signs present on or before May 12 that suggest injury had occurred previously and was progressive.”
He said that Chelsea had become jaundiced prior to any alleged attack, a claim made by one of her friends, which suggests it was caused by the fall.
However, Dr Alfredo Walker, a former Home Office pathologist who a carried out a postmortem on Chelsea days after her death, disagreed with the claims.
Speaking via videolink from Canada, Dr Walker told the hearing: “The pancreas is well protected and is usually injured with a severe degree of blunt force.
“In my experience, and my colleagues’ experience, we are not aware of any cases reported like this.
“We see intoxicated people getting injured quite frequently but I’ve never seen anyone with a lacerated pancreas from a standing fall.”
The inquest, which is expected to last three days, continues.