[Forensic Life] The Stomach Knows the Culprit

The stomach (胃·stomach) is a digestive organ. The stomach is the part that digests food sent from the mouth through the esophagus. It functions in digestion by churning and secreting gastric juice containing digestive enzymes to break down food into smaller pieces. Generally, when people say they have a "burning sensation" or feel "bloated," and undergo a gastroscopy at a hospital, the examination observes whether there is inflammation in the gastric mucosa, whether there are ulcers where the mucosa is deeply eroded and damaged, or if there are tumors, to make a diagnosis. Forensic pathologists also examine the gastric mucosa in detail, much like gastroenterologists performing endoscopy. The difference is that the stomach viewed by a gastroenterologist during endoscopy is empty, whereas in an autopsy, the stomach contents are inspected and smelled to determine what was eaten, and the gastric mucosa is examined together, a process that takes more time than an endoscopic examination.

In the mid-1990s, before 9 a.m., white smoke was seen coming from an apartment in the northern part of Seoul. Within about 10 minutes, the apartment security guard witnessed the fire and called 119, and firefighters arrived within 10 minutes to extinguish the fire. The fire started in the master bedroom closet. While inspecting the interior of the house, firefighters found an adult woman and a 2-year-old girl, presumed to be her daughter, dead in the bathroom bathtub. Both showed signs of strangulation with a cord and were submerged in the bathtub water. It was a clear homicide, and the fire was undoubtedly arson intended to conceal evidence.

The husband was identified as the suspect. He was a doctor. He testified that when he left the house at 7 a.m., his wife and daughter were still alive, and the time he arrived at the hospital at 8 a.m. was confirmed by others. At that time, the victims were submerged in water, and the police did not measure the temperature of the water in the bathtub where the bodies were found, making it difficult to determine the time of death based on body temperature, livor mortis, and rigor mortis. Ultimately, a focused analysis of the stomach contents was conducted to estimate the time of death based on digestive capacity.

The deceased woman’s stomach showed only partially digested contents. About one bowl of white rice and seaweed from seaweed soup eaten the previous evening remained intact. The husband said she had eaten bean sprout soup in the morning, but no bean sprouts were found in her stomach. Based on this, the author’s mentor and a professor from Korea University who performed the autopsy on the Park Jong-chul case suggested that the woman likely died around midnight of the previous day or in the early morning of the day of death.

However, Thomas Krompecher, a renowned Swiss forensic pathologist hired by the husband’s defense, argued that the degree of digestion varies among individuals, that it is not accurate to visually confirm digestion of stomach contents during autopsy, and that digestion may continue even after death, so estimating time of death based on stomach contents is not appropriate. The Korean courts initially sentenced the husband to death in the first trial, acquitted him in the appellate court, and after the Supreme Court remanded the case with a guilty verdict, the final appellate court acquitted him after much deliberation. Although many other issues were intertwined, this was a case where the forensic evidence based on stomach contents was rejected.

In a different case in the southwestern region of Seoul, where a woman and her son were brutally murdered with a knife inside their residence, a somewhat different verdict was finalized. The suspect was again the husband. To determine whether the murder occurred at the time the husband visited, it was necessary to specify the time of death, and once again, analysis of stomach contents was unavoidable. On examination, onion, vegetables, nuts, and tomatoes that had been shared were found in the stomachs of the woman and her 4-year-old son. The degree of digestion of the stomach contents was consistent.

During questioning by both defense and prosecution, it was explained that generally, gastric motility begins about 10 minutes after swallowing food, light meals empty the stomach within 2 hours, moderate meals within 3 to 4 hours, and heavy meals within 4 to 6 hours (gastric emptying time). However, in this case, since undigested solid matter, presumed to be tomatoes, was found in both victims’ stomachs, it was reasonably inferred that death occurred within 4 hours after eating. This was considered evidence that death occurred at the time the husband visited. Considering other issues as well, the guilty verdict was upheld in the second trial and finally confirmed by the Supreme Court.

On a cold December night, his figure seen on the apartment CCTV was staggering. He was dropped off in the apartment parking lot by a designated driver and seemed to have a brief scuffle with the driver but soon staggered and disappeared into a blind spot of the camera. He was found the next day in a corner of the parking lot. He had celebrated a promotion to a mid-level management position at a reputable company with friends over drinks.

Around midnight, he called his wife to say he would call a designated driver, but his wife, who had briefly fallen asleep, realized he had not come home. She went to the parking lot and found him sitting behind a parking pillar. He had abrasions on his chin and was unconscious. She urgently shook him awake and called 119, but the paramedics confirmed his death upon arrival. The police suspected foul play based on the CCTV footage showing the scuffle and the chin injury.

His body on the autopsy table was bright red. This is a common finding in death by hypothermia, but the internal examination was conducted. The stomach mucosa contained sour-smelling gastric contents mixed with alcohol (later confirmed blood alcohol concentration was 0.155%). After removing the contents, mottled mucosal hemorrhages (Wischnewski Spots), resembling a leopard pattern typical of hypothermia deaths, were observed. The chin injury was judged to have been caused by a fall and was unrelated to the cause of death. Microscopic examination of the gastric mucosal hemorrhage showed a typical pattern seen in hypothermia deaths. After completing the autopsy, the family was informed that the cause of death was hypothermia.

In addition, forensic pathologists routinely analyze stomach contents by smelling and examining what was eaten under a microscope, observing the gastric mucosa, and analyzing tissues to uncover the truth in cases such as cyanide poisoning and salt poisoning. Even a single organ like the stomach often holds many ‘signs’ that suggest important clues to forensic pathologists. However, except for the special cases mentioned above, it remains difficult to confidently estimate time of death based on stomach contents in court.

The author is conducting research on the digestion rate over time of stomach contents in Koreans in collaboration with the Department of Gastroenterology at Seoul National University Hospital. Most foreign studies are based on Western diets, which differ from Korean diets, so independent research is necessary. Although applying for such research funding often reduces the likelihood of receiving grants, the author wishes to express gratitude through this article to Professor Kim Sang-gyun, who is planning and conducting this research together.

Yoo Seong-ho, Forensic Pathologist