An 85-year-old woman, with a high-grade fever (40°C) and abdominal pain, was referred to our hospital. Blood examination revealed an elevated white blood cell count (25.8×10⁹/L) and elevated levels of C reactive protein (8.54 mg/dL), alanine aminotransferase (95 IU/L), aspartate transaminase (138 IU/L), alkaline phosphatase (804 IU/L), gamma-glutamyl transpeptidase (703 IU/L), and total (5.0 mg/dL) and direct (3.2 mg/dL) bilirubin. Contrast-enhanced CT (CECT) was performed (figure 1).

(A, B) Axial view of the contrast-enhanced CT. (C and D) Coronal view of the CECT. CECT showing massive paraesophageal hernia, with prolapse of the stomach, duodenum (white arrow), and pancreatic head (yellow arrow), with bile duct stenosis (red arrow).

What is the diagnosis?