Objective: To review the experience in emergency treatment of ruptured abdominal aortic aneurysm (rAAA) and explore the perioperative risk factors. Methods: The clinical data of 27 patients with rAAA admitted from January 2007 to September 2015 were reviewed. Of the patients, 20 cases were male, and 7 cases were female, with a median age of 72 years; 18 cases underwent open surgery and 6 cases had endovascular repair (including one case of hybrid surgery). The diagnosis and treatment procedures, perioperative conditions and postoperative follow-up results were summarized, and the perioperative risk factors were also analyzed. Results: Pre-, intra- and postoperative death occurred in 3, 1 and 9 cases respectively. The causes for postoperative death included acute renal failure, acute respiratory failure, abdominal compartment syndrome, myocardial infarction and hemorrhage of digestive tract, all which finally led to multiple organ dysfunction syndrome. The overall successful salvage rate was 51.9% (14/27), which in open surgery was 50% (9/18) and in endovascular repair was 83.3% (5/6), respectively. Comparison of the clinical variables between patients who survived and those who died during the perioperative period showed that there was significant difference in time from onset to admission, preoperative systolic blood pressure, preoperative serum creatinine concentration, intraoperative blood loss, volume of transfusion and intraoperative urine output (all P<0.05). Conclusion: As rAAA is a lethal condition with high mortality, definitive diagnosis should be made as soon as possible to ensure emergent surgical repair to control the hemorrhage, and enhanced perioperative management is equally important. Endovascular repair is an effective approach for emergency treatment of rAAA.