Source: Rom J Leg Med 34: 39–46, 2026; DOI: 10.4323/rjlm.2026.53
Kristina Baumjohann, Mark Benecke
Abstract: Stomach contents can – together with other medico-legal methods – be used to narrow down time since death. Two cases (suffocation/bolus in a nursing home & abduction/homicide) presented here as well as the scientific literature show the use of the method to verify statements related to criminal investigations.
Keywords: Stomach contents, determination of time of death, statements, information content
INTRODUCTION
Figure 1. Stomach contents with predominantly grain-like components.
Forensic examinations of stomach contents in deceased individuals have been conducted for over a century. Corin investigated the gastric dwell time of coffee in living subjects as early as 1898 [1]. Three years later, Farrai (1901) conducted studies on the postmortem digestion of protein in dogs [2]. Due to the continued transport of food in the stomach after death, he deemed this method unsuitable for calculating the time of death. Various (animal) experiments on postmortem digestion have been conducted in recent decades [3, 4]. Merkel (1922) also demonstrated possible continued digestion after death in his work, but considered it insignificant due to the small quantity [5]. Madea et al. (1986) confirmed this in an animal experiment [6]. Henssge & Madea (2004) noted the bacterial decomposition of food after death [7].
Sorge (1904) advocated using stomach contents to obtain information about the time of death [8]. Holczabek (1961) was of the opinion that small and large intestine contents should also be used to provide information about the time of the last meals and their composition [9]. If the time between the last food intake and the time of death, as well as the composition of the food, is known, the stomach contents — along with other forensic methods — can provide rough indications of the time of death.
However, the stomach contents can also provide interesting clues about the circumstances of death. If the time of death is not precisely established or if several times are possible, the stomach contents can narrow it down (“earlier,” “later”). The type of meal, the time of day (e.g., breakfast, lunch), the location of the meal (e.g., a specific meal at a restaurant, a visit to friends, etc.), and the verification of statements and interpretations for temporal reconstruction should not be neglected [7]. The significance of stomach contents is not only relevant in the context of forensic medical examinations. Other medical and scientific fields have also conducted research on this topic and investigated gastric emptying in relation to anesthesia prior to surgery (“fasting”) [10-12].
Grover & Camilleri (2013) investigated the influence of antidepressants on gastric activity in patients with irritable stomach and irritable bowel syndrome [13]. For example, buspirone affects the stomach’s ability to relax, which is necessary for food intake (volume increase), while tricyclic antidepressants delay gastric emptying. These findings may also be relevant for questions in forensic medicine. In an archaeological context, Dickson et al. (2000) analyzed the large intestine contents of the glacier mummy “Ötzi” using isotope analysis to investigate his diet at the time [14]. Plant fragments can provide not only archaeological evidence, but also forensic clues: The presence of diatoms in the stomach can indicate death by drowning [15, 16].
Figure 2. Seed-like grains from the stomach.
Besides food residues, other substances in the stomach are also revealing: Lang (2015) found soot particles and carbon monoxide in the stomachs of some burned corpses, which he interpreted as signs of life during the fire [17]. Hemorrhages in the gastric mucosa not caused by stomach contents can – among other findings – indicate death from hypothermia [18-22]. These hemorrhages are also called Wischnewski spots [19, 22] (or Wichniewski [21] or Wischnewsky spots [18]).
Pope (2012) reports on a robber who was shot during a robbery. The contents of his stomach led to the identification of his accomplice, who had escaped [23]. Typical burger remnants (ground beef, cheese, bacon) and French fries were found in the deceased’s stomach. One French fry was undigested, indicating that the meal had been eaten no more than an hour before death. The medical examiner was able to attribute the thicker French fries to a specific fast-food chain, a branch of which was located in the immediate vicinity of the crime scene. The store’s surveillance system showed the deceased robber with his accomplice, who was subsequently identified.
In a case report by Kerscher et al. (2024), a 70-year-old man lost consciousness in a sauna and sustained third-degree burns [24]. He died in a burn clinic 11 days later. His stomach contained approximately 200 ml of thickened gruel with coarse plant matter, which was not found in the duodenum or subsequent intestinal segments. The stomach contents must therefore have been the last meal the man had consumed before entering the sauna. The complete absence of gastric emptying for eleven days is described here for the first time. The authors question the use of the stomach contents to infer the time interval between the last food intake and death.
Figure 3. Plant components from the stomach.
A similar case was reported by Püschel (1996) [12]: A 15-year-old boy suffered burns covering 50 percent of his body surface and died of sepsis after 10 days of intensive care treatment. Green beans, which he had eaten before the burn event, were found in his stomach. Injuries and diseases of the digestive tract can apparently slow down or even stop the gastric dwell time of food components for an unknown period.
Püschel (1996) illustrates this with another case: A 52-year-old alcoholic died from gastric bolus after 14 days of treatment for an extensive subdural hematoma [12]. During this time, he was exclusively fed artificially.
A 3 x 10 cm food bolus from the stomach blocked the laryngeal inlet, and had remained in the stomach for over 14 days without being transported further or digested. Tröger (1987) also points to a cessation of gastric emptying in cases of severe traumatic brain injury [25].
In forensic medical practice, it should be noted in such cases that there is “no ‘reliable’ time limit regarding whether gastric emptying has occurred.” [12]. Tablet residues in the gastrointestinal contents can provide evidence of poisoning and further information about the circumstances of death (e.g., suicide) [26]. For this purpose, the quantity and composition of the ingested substance(s) must be known. In addition to chemical analysis of the substances, the type and quantity of certain excipients or fillers in tablets (e.g., types of starch and cellulose) can be examined using a polarizing microscope. This method can also be applied to tablet residues in glasses, residual liquids, inhaled fluids, or vomit.
Figure 4. pH value determination of stomach contents.
Singh et al. (2016) describe the murder of a young woman [27]. During the police investigation, her husband and his brother, as well as her own brother, gave conflicting statements. The men’s statements were verified on the basis of the partially digested rice found in the victim’s stomach: The woman had ingested the rice approximately two to three hours before her death. This finding contradicted the statements of the husband and his brother.
Stomach contents were also used to verify statements in another case: Pieri et al. (2018) examined the proteins in the stomach of a 40- year-old patient who apparently died in a hospital around 9 a.m. as a result of a fall [28]. The nurses testified that the man had refused breakfast. 350 g of a whitish, semi-liquid mass was found in the deceased’s stomach. An analysis of the proteins contained within showed that they were digested milk and bread proteins from the breakfast eaten that same day. Due to the discrepancy between the forensic findings and the staff’s statements, an investigation into possible negligence was initiated.
The composition of stomach contents can also provide information based on its physical properties: Gotsmy et al. (2018) and Jackowski (2023) point to the characteristic three-layered stomach contents in cases of drowning [29, 30]. This is due to the ingestion of varying amounts of water. This layer settles at the top (so-called “Wydler’s sign”), and indicates drowning deaths. Cases without drowning show two-layered stomach contents. In this context, Gotsmy et al. (2018) point out possible discrepancies in the number of gastric contents layers between PMCT (postmortem CT) and the forensic examination [29]. These are likely due to the technique used to collect the gastric contents in the autopsy room, as well as to movement of the body during the autopsy or before/after PMCT.
The examination of the gastric contents is preceded by the identification of the food components, which can be difficult with highly digested foods. Baur et al. (1982) demonstrate how to differentiate between milk and cheese using double diffusion tests and specific sera [31].
Figure 5. Throat contents with three crumbs.
Plant components have diverse structures and are sometimes difficult to identify. In our experience, the work of Spann (1978) [32] and the laboratory handbook by Bock et al. (1980) [33] are good reference works for the identification of plant cells. Various factors influence the gastric emptying rate and the digestive state of food. Water is emptied more quickly than carbohydrates [11], and the latter are emptied more quickly than mixed foods [26]. The gastric emptying process slows with increasing carbohydrate and triglyceride content [34] In addition to the fat and energy content and the volume or weight of a meal [7, 35-37], the physical and chemical properties of the food (e.g., temperature, pH) also play a role [38]. Jatti et al. (2010) identify three categories of factors influencing gastric emptying: psychological, physiological, and anatomical circumstances [38].
Since gastric emptying is controlled not only by predominantly physiological factors but also by emotions, the latter being particularly significant in criminal cases, as gastric emptying can be accelerated by anger and aggression, slowed by depression, anxiety, and stress, or even stopped by the parasympathetic nervous system in cases of shock, fear, or head injury, thus halting the production of gastric acid [35, 36, 38-40]. Undigested food can then be found in the stomach even after 24 hours [38]. Further influencing factors and their effects on gastric emptying are listed in Table 1.
Additional factors affecting gastric emptying are listed in a table in Henssge & Madea (2004) [7], Jaffe (1989) [45], and Legge et al. (2016) [36].
There are differing reports regarding the duration of gastric emptying: According to Patel et al. (2013), the stomach is generally emptied after 2.5-6 hours [46]; Grassberger & Schmid (2009) report 2-4 hours with a wide range of variation [47]; and according to Kaul et al. (2017), emptying takes 4-6 hours [48]. The latter investigated the emptying rate(s) in 507 cases with known time of death and last meal. While the digestion status of the food proved significant in calculating the time of death, this should only be considered in conjunction with other factors for calculating the postmortem interval (PMI). Grassberger & Schmid (2009) also consider estimating the time of death solely based on stomach fullness and food composition to be insufficiently accurate [47]. This is understandable, given the factors listed above that influence gastric emptying.
We present two cases from our expert witness practice, in which the stomach contents of deceased individuals allowed for both inferences about the time of death and the verification of statements.
CASE 1
A married couple was held captive for two to three days and then murdered. We were tasked with determining when the deceased man had consumed the meal found in his stomach.
Methods and findings
The stomach contents were delivered in a PE container approximately 8 cm high and 5 cm in diameter, inside a polystyrene box with cooling elements, and were frozen upon delivery (3-star freezer compartment). Two hours before the start of the examination, the 53 g of stomach contents (measured on a Kern 440-35N precision balance) were thawed at room temperature and transferred to Petri dishes that had been previously wiped with methylated spirits. Under the binocular microscope (Leica Mz 12.5), 20 g of the predominantly deep dark grey colored stomach contents were examined in more detail and pieces were sorted according to color, shape, and size (Fig. 1).
Seven groups of relatively uniform, still easily identifiable components could be separated:
1. Coarse, soft, gelatinous pieces about one centimeter long, with distinct cut edges.
2. Larger, gelatinous pieces measuring over one centimeter, mostly sharply defined (with distinct cut
edges).
3. Seed-like granules about two millimeters in diameter with a smooth surface or a surface marked by small indentations: Two different types of seeds or grains (Fig. 2).
4. Seed-like granules about five millimeters long and three millimeters wide, reddish-brown.
5. Soft, light-colored components with simple longitudinal grooves, about three to four millimeters wide and about six millimeters long.
6. Larger, partly limp pieces, probably from plant parts, possibly husks.
Figure 6. Bean fragments from the stomach.
7. Smaller, reddish-brown husks, probably from plants, and a single pear-shaped component (Fig. 3). Four ml of sterile, distilled water were added to the remaining stomach contents for pH measurement using a Merck universal indicator (pH 0-14). The displayed pH value (between pH 3 and 4: acidic) indicated an acidic environment, which is normal for the stomach (Fig. 4).
Interpretation of the findings
The glassy, gelatinous structures (group 2) were classified as fig components by a botanist we consulted. This was consistent with the subsequent police report that a package of dried figs had been found at the scene.
The predominantly three- to five-millimeter-long, plant-like, grain-like structures (such as those from a grain-based dish or bread) (groups 3, 4) were consistent with the discovery of a muesli package at the scene, which had been reported later.
The botanist observed a similarity between the components reported from group 5 and unhulled grains of wheat, rye, barley, or oats, as distinct from pearl barley, which consists of hulled grains.
Environmental influences
It is known that some plant components do not (need to) be broken down in the stomach, but can pass through the intestines and be excreted undigested. This applies particularly to grains and other plant components with low water content, or those that are poorly chewed. Based on our previous experience with stomach contents, it seemed unusual and relevant that the aforementioned soft, yet sharply defined components of the stomach contents resembling cut edges were (still) present. This usually indicates that the decomposition of the food did not last long.
Factors such as hasty swallowing (and thus little chewing and salivation) [5], as well as whether the person ate regular meals, must be considered in the present case (kidnapping with murder). According to the literature, stress and anxiety also slow down digestive activity in the stomach [38]. This appears to be the case here as well: According to our information, the murdered person was alive for several hours in the perpetrator’s custody.
A prolonged death struggle has a similar effect. However, this does not appear to apply here. According to our information, liquid blood was found in the heart, which the forensic medics interpreted as an indication of a rapid dying process.
Figure 7. Small bean fragment from the stomach. Scale: mm.
Medical literature generally assumes that ingested food remains in the stomach for approximately two to six hours and is then transported to the intestines [46-48]. In a study of 100 stomach contents from cadavers, Patel et al. (2013) demonstrated that the presence of still identifiable food components indicates a time since eating of less than two hours [46]. Given the visible cut edges in the stomach contents available to us here, we would assume a time since eating of approximately two hours to a maximum of six hours. The aforementioned factors, which likely influenced this case, must be taken into account.
CASE 2
A man died in a nursing home during dinner. On that day, the deceased had the following meals: For breakfast, he reportedly only drank coffee and ate nothing. For lunch, he had beef roulades with noodles, mixed vegetables, and rhubarb compote. He allegedly ate very little of this. For dinner, he had sausage meat, cheese, bean salad, bread (brown or dark whole-grain bread), and butter. According to his caregiver, the deceased had eaten two slices of bread with sausage in the evening. In an unsupervised moment, he may have put a slice of bread with butter in his mouth and choked to death.
We were asked to conduct a morphological examination of the food residues from his throat and stomach in order to “determine with sufficient certainty what food the deceased had consumed immediately before his death.”
Methods and findings
We received samples from the throat and stomach separately and unrefrigerated in two lidded plastic containers, which were frozen immediately upon arrival in a 3-star freezer until analysis.
Throat contents
The throat contents, weighing approximately six grams (scale: Philips HR2385/A), were brownish and liquid (Fig. 5). Three clearly large lumps were white inside and encased in a dirty dark gray outer layer; the consistency resembled cream cheese. No other solid components were discernible. Overall, the liquid in the throat contents was quite dark, which could possibly indicate the presence of dark whole-grain bread. The lighter components could have been from cheese.
Stomach contents
The significantly lighter stomach contents weighed approximately 230 g and contained several larger, more solid components that, based on their color and appearance, resembled elongated bean segments (Fig. 6). No other solid components were present.
The stomach contents surrounding the pieces were completely uniform, creamy-mushy, with small white flecks (less than one millimeter); a single angular piece was also found, about one millimeter in size, resembling a green herb or vegetable. The stomach contents were examined under a light microscope at 60x magnification (binocular microscope: Leica MZ 12.5): The pieces were presumably a piece of bean, as their thickness and color were similar to the other pieces.
A total of 19 possible bean pieces, ranging in length from 5 mm to 21 mm, were recovered from the stomach contents (Fig. 7). A sweetish odor, similar to vomited cocoa, was noticeable; however,
this could also be due to the decomposition of sugar components (carbohydrates) from bread. At eight times magnification, numerous small white particles were visible on the bean pieces. These white particles were very easily crushed with tweezers; they could, for example, have been cheese with a significant fat content (Fig. 8).
Figure 8. Possible fatty components in stomach contents.
Small, greenish-red to brownish, very thin platelets could have been from herbs. The pH of the samples was measured using pH indicator strips from Merck (pH 0-14). Tap water used as a control sample showed a pH of 7, while the pharyngeal contents and stomach contents were both at pH 3-4.
A rapid blood test using Bayer Hemastix (batch: 6H18A) showed a blood count of more than 80 erythrocytes per microliter in the stomach and pharyngeal contents (Fig. 9). The test is extremely sensitive, so even the smallest traces of blood—even extremely diluted amounts—can trigger a positive result.
Interpretation of the findings
The acidic pharyngeal contents could be due to the food itself (vinegar, etc.) or to the person having regurgitated stomach acid or vomited. Possible bacterial decomposition during transport could also have affected the pH value, as the samples did not arrive frozen.
The amount of blood present in the stomach was not necessarily due to injury. It could also have been introduced from the autopsy instruments, gloves, or storage containers from the autopsy room.
Figure 9. Rapid blood test.
Under 100x magnification with a binocular microscope, a drop of stomach contents containing the previously described small, whitish particles, as well as dried herb-like platelets and air bubbles (likely from fermentation), showed numerous white particles, similar to a fat emulsion. A histological examination did not appear strictly necessary given the very homogeneous and easily examined material, as no components that were unusual or inconsistent with the descriptions so far were immediately apparent in the submitted material.
The man had apparently died while eating the described dinner.
In conclusion, stomach contents alone should not be used to determine the time of death. However, the cases we have presented and the scientific case reports show that they can be useful for verifying statements and addressing other questions in a criminal case, and their potential informational value should therefore not be disregarded.
References
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