Postmortem computed tomography identified indigestible umeboshi pit surrounded by maggot masses in oral cavity suggesting food-related choking in a decomposed body.

Determination of the cause of death is a fundamental task in forensic medicine. However, this becomes particularly challenging in cases of decomposition, where critical findings necessary for diagnosis are often obscured by putrefaction or insect activity. Here, we report a case of a man in his 70s who went missing during a summer hike and was found approximately 10 m below a trail after four days, in a state of moderate decomposition with heavy maggot infestation. Postmortem computed tomography revealed no major traumatic injuries but identified a high-density, oval-shaped foreign body, measuring approximately 2 cm, in the oral cavity. Autopsy confirmed this as the pit of a pickled plum (umeboshi), retrieved from a cluster of maggots. The stomach contained plum paste, rice, and seaweed, which were typical components of a Japanese rice ball (onigiri). These findings suggested that the deceased died while eating onigiri, implying that the cause of death involved food aspiration-related choking, although decomposition prevented definitive identification of airway obstruction and other cause of death could not be evaded completely. In this case, postmortem computed tomography enabled detection of evidence that would likely have been missed or displaced without imaging, especially given the moderate postmortem changes. It was demonstrated that, even in decomposed bodies, persistent foreign materials such as an umeboshi pit could serve as useful circumstantial indicators in forensic investigations. This case illustrates the importance of integrating imaging and autopsy approaches in elucidating causes of death in complex forensic cases.