Sclerosing encapsulating peritonitis (SEP) is an inflammatory condition characterized by the encasement of the small bowel in a dense fibro-collagenous membrane resulting in acute bowel obstruction. In the context of liver disease, SEP is exceptionally rare, with only eight known cases to date. We describe the case of a 52-year-old male presenting to a rural hospital with acute small bowel obstruction secondary to SEP in the setting of decompensated liver cirrhosis. SEP is an uncommon cause of acute small bowel obstruction. Definitive treatment requires surgical intervention, typically with enterolysis and excision of the abdominal cocoon. For patients with cirrhosis, this is associated with exceptionally high perioperative morbidity and mortality. SEP is an important differential in cirrhotic patients presenting with acute bowel obstruction, particularly in the context of long-term beta blocker use. Early discussions regarding prognosis and careful patient selection for surgical intervention are of paramount importance.