This video article presents a repeat exploratory laparotomy for encapsulating peritoneal sclerosis in a patient with end-stage renal disease and myasthenia gravis. The surgery involved adhesiolysis and meticulous dissection of a fibrotic peritoneal capsule that was causing bowel obstruction. A twisted band in the right lower quadrant, approximately 20 cm proximal to the ileocecal valve, was lysed to relieve the obstruction. The appendix was removed, and a suspected serosal tear on the ascending colon was repaired. Hemostasis was achieved using absorbable powder. This case highlights the complexity and high-risk nature of surgical management for encapsulating peritoneal sclerosis.