2 years old boy with trisomy 21 was referred to PICU of SGHDubai with respiratory distress and multiple Lung consolidations. Child was stabilized and assessed thoroughly which revealed presence of extremely rare bilateral Morgagni’s hernia in the diaphragm. Almost half of thoracic cavity was filled with abdominal contents leading to collapse consolidation of bilateral lung tissues. Early surgical correction was undertaken. A huge defect measuring 20×15 cm2 was found in the diaphragm through which most of colon, right lobe of liver, stomach , omentum and small bowel was found herniating into the chest. The contents were reduced into abdomen, the hernial sac was excised from chest and heart, the diaphragmatic defect was repaired and space was created for the lungs to expand and function properly. The child had critical post operative management in PICU and on 4 th post operative day he was extubated and chest tubes were removed . On 5 th day he is on room air , active and with normal respiratory efforts, started on oral diet. Considering the size and extent of this rare diaphragmatic hernia and it’s pulmonary consequences , the child had extremely favorable outcome. The critical perioperative Care was provided by PICU team and operative Anaesthesia was excellent.