Contraddittorio col CTU, finalmente uno assolutamente professionale!

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In verità non si tratta del primo “vero” contraddittorio col CTU: questo è particolare perché nasce da un 696bis positivo per gli attori in cui non si è transatto

In breve la storia sintetizzata nelle risposte ai quesiti del CTU del 696bis:

“…Al momento del ricovero del 10.1.2017 il sig. TT presentava un quadro di occlusione intestinale (con alvo chiuso a feci e gas da 2 giorni) in soggetto pluri-laparotomizzato; il paziente era inoltre affetto da enfisema bolloso in bronco-pneumopatia cronica ostruttiva, da esiti di intervento per aneurisma dell’aorta addominale ed era in terapia antitrombotica, anti-anginosa, broncodilatatoria, antiasmatica, antidislipidemica ed ansiolitica.

Al Pronto Soccorso dell’Ospedale di FF il paziente è stato sottoposto ad un esame radiologico dell’addome (che faceva rilevare la presenza di livelli idroaerei multipli) ed a consulenza chirurgica con indicazione al ricovero ospedaliero; subito dopo l’accettazione nell’U.O. di Chirurgia Generale veniva richiesta una TC urgente dell’addome senza e con m.d.c. che rilevava una marcata distensione intestinale a monte di tratto stenotico con anse collabite a valle e con versamento libero. Considerate le condizioni generali del paziente, le precedenti multiple laparotomie ed il quadro oggettivo in miglioramento, considerato che una occlusione intestinale può anche risolversi con la terapia conservativa (così come era avvenuto in occasione di precedenti ricoveri), vi era indicazione all’intervento chirurgico dopo una breve osservazione in unione ad un tentativo di terapia conservativa; la scelta terapeutica effettuata è stata pertanto corretta.

Considerata la situazione addominale con esiti di ripetute laparatomie, raccolte intraperitoneali e complicanze infiammatorie (fattori, questi, che avevano provocato una gravissima forma di diffuse e tenaci aderenze tra i visceri), l’intervento chirurgico di necessità presupponeva la risoluzione di problemi tecnici di particolare difficoltà. Ad aggravare la situazione, inoltre, vi erano le condizioni polmonari precarie ed il fatto che ogni intervento chirurgico comportava la formazione di nuove aderenze intestinali. D’altra parte, in caso di conclamata occlusione intestinale refrattaria alla terapia conservativa, l’intervento chirurgico era l’unica terapia possibile.

Durante l’intervento di viscerolisi dell’11.1.2017 l’operatore ha inavvertitamente perforato l’intestino ileale. Tale perforazione ha provocato una peritonite diffusa con shock settico che ha portato al decesso il sig. TT.

Pur ammettendo la difficoltà tecnica dell’intervento chirurgico, la lesione perforativa poteva essere evitata con maggior prudenza e, in tutti i casi, doveva essere diligentemente diagnosticata de visu o, eventualmente, con idonee prove idro-pneumatiche, e correttamente suturata. Nel caso in esame pertanto è possibile individuare specifici profili di imprudenza e/o negligenza là dove l’operatore, invece di migliorare la patologia presente, l’ha colposamente aggravata”.

Quindi si partiva da questa ctu che dava ragione all’attore, ma non essendo arrivati a transazione i convenuti resistevano in giudizio per vizi di motivazione della ctu su un punto specifico (perforazione versus ischemia della mesenterica).

Come pensate che sia avvenuto il contraddittorio col CTU?

Ha iniziato il sottoscritto a difendere la relazione del ctu precedente (696bis) e il rinominato ctu specialista chirurgo interrompeva le parti proponendo una sua ricostruzione degli avvenimenti prendendo posizione sulle criticità del caso clinico e della ctu del precedente ricorso 696bis.

Evidenziate le criticità del caso clinico il ctu specialista in chirurgia generale ha ridato la parole alle parti che hanno espresso il loro parere, anche in contraddizione col ctu.

Il ctu, infine, ha richiesto alla parte convenuta i cd delle TC addome per effettuare una diagnosi differenziale tra perforazione ischemica e iatrogena, comunicando che la risposta delle sue indagini l’avrebbe resa nota a tutte le parti.

Insomma, sapete cosa significa tutto questo?

Che il contraddittorio col ctu è fondamentale perché le parti tornano a casa sapendo cosa ci sarà scritto sulla bozza di ctu avendo, così, la possibilità di comunicare ai legali rappresentanti le verosimili conclusioni del collegio peritale tanto da poter facilitare una transazione prima della bozza di ctu.

Ma non solo questo!

Malgrado la mia non condivisione parziale delle riflessioni del ctu chirurgo, ho terminato la seduta contento di averla fatta, perchè è un piacere fare un sano contraddittorio con chi decide le sorti del caso medico legale (collegio peritale). E’ questo il motivo stesso della seduta peritale.

Avere a che fare con un collegio peritale “mummia” è controindicato anche per la salute psichica!

Dr. Carmelo Galipò

(Pres. Accademia della Medicina Legale)

Leggi anche:

696bis o mediazione, cosa conviene fare? Ecco alcune nostre proposte

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