A case of accidental intracranial penetration of a 29-cm-long portion of nasogastric tube (NGT) in a 27-year-old female victim of a severe homicidal skull and brain trauma is reported. Accidental penetration of the NGT occurred through a large fracture of the ethmoid lamina cribrosa. In addition to a systematic review of previously reported cases, circumstantial data, clinical aspects, and autopsy data have been analyzed to draw medicolegal considerations concerning the connection between death and insertion of an NGT, which may also contribute to the ascertaining of any possible professional responsibility of medical staff, in a case fraught with numerous legal complications.