Introduction: The rupture risk of abdominal aortic aneurysms (AAAs) depends primarily on their diameter and increases exponentially with aneurysm growth. Therefore, giant AAAs, defined as > 13.0 cm in diameter, are rare clinical entities. Report: A giant ruptured AAA that measured >20 cm in diameter was successfully treated by open repair. Conclusion: It remains unclear why giant AAAs continue to grow to extreme size without rupturing. Open repair seems to be the treatment of choice for most giant aneurysms, both ruptured and unruptured.