Drowning remains one of the most complex and controversial causes of death in forensic medicine. Establishing the diagnosis of drowning is often difficult due to the absence of pathognomonic macroscopic signs and the influence of postmortem changes. In this regard, histological examination of organs and tissues plays an important role in supporting the forensic diagnosis. The aim of this review is to analyze current international scientific data on the histological criteria used in the diagnosis of drowning in forensic practice. The article summarizes the results of modern studies devoted to histopathological changes in the lungs, brain, liver, kidneys, and other organs observed in drowning cases. Particular attention is given to pulmonary edema, alveolar overdistension, the presence of foreign particles, and other microscopic findings that may indicate aspiration of water. In addition, the diagnostic value and limitations of histological examination in drowning cases are discussed. The review also highlights the importance of a comprehensive forensic approach that includes histological analysis together with autopsy findings, circumstantial evidence, and laboratory methods. The analysis of international literature demonstrates that histological examination remains an important auxiliary tool in the forensic diagnosis of drowning, although it should always be interpreted in conjunction with other forensic data.