Mortality due to the surgical treatment of ruptured abdominal aortic aneurysms (RAAA) is high, more than 40%, especially in elderly patients. The literature concerning RAAA in very elderly patients is analyzed by Internet research (Medline). Only rare examples of emergency surgical management in nonagenarian patients are reported, and even fewer reports of successfully operated patients. A case report of a successful surgical repair of RAAA in a nonagenarian is presented. After ultrasound (US) and CT scans, the patient (in good condition as regards blood pressure, respiratory, cardiac and renal function) underwent uneventful aneurysmectomy and reconstruction of the aorta and common iliac arteries by means of a bifurcated prosthesis. The length of hospitalization was 30 days and the patient is still alive and in good condition four years and two months after the operation. The advisability of emergency surgical repair in these patients, questionable because of the excessive surgical risk and poor survival benefit, is discussed. However many other factors affect the outcome of emergency repair (mainly cardiac, respiratory and renal function), independently of age. The authors conclude that age per se does not limit the indication for or success of surgery in very elderly patients.