Beyond the last meal: a medico-legal framework for interpreting gastric contents in death-time reconstruction

Gastric contents have long been used in forensic pathology to infer the interval between the last meal and death. Although intuitively attractive, this approach remains biologically variable, poorly validated, and vulnerable to medico-legal overinterpretation, particularly when findings are translated into narrow courtroom timelines. This structured state-of-the-art review synthesizes historical, physiological, forensic, and medico-legal evidence on gastric content analysis in death-time reconstruction. Searches were conducted in PubMed/MEDLINE, Scopus, and Web of Science, with additional targeted citation chasing. Thirty-seven sources were included and narratively synthesized. The evidence indicates that gastric emptying is strongly influenced by meal composition, individual physiology, disease, alcohol, drugs, trauma, shock, critical illness, agonal physiology, and post-mortem change. Even under favourable conditions, available quantitative data support only broad probabilistic intervals, not precise estimates of death time. We therefore propose shifting the inferential target from post-mortem interval estimation to last meal-to-death compatibility. A five-step interpretive framework is presented to define the question, document gastric findings, assess modifiers, integrate independent evidence, and report uncertainty. Calibrated terminology is recommended to reduce expert overstatement and promote scientifically defensible forensic opinions in reports and testimony. This approach preserves the forensic value of gastric contents while acknowledging their epistemic limits in individual casework and practice.