The Binding of Isaac: Repentance

This is a 2D action-adventure game in which players help a child, Isaac, escape from being violently harmed by his mother. From a top-down perspective, players solve puzzles and traverse basement dungeons filled with trapped children and fantasy creatures. Players use various weapons (e.g., teardrop projectiles, toxic flatulence, streams of blood) to kill enemies. Attacks are highlighted by blood-splatter effects, dismemberment, and decapitation; several dungeons are littered with blood pools and entrails. Some rooms depict large amounts of feces and urine on the floor; certain items allow players to defecate, urinate, or transform into excrement-themed characters. During the course of the game, players' character can consume a Wavy Cap mushroom, resulting in psychedelic imagery and screen-distortion effects. One cutscene briefly shows a cloud character raising its middle finger (i.e., flipping the bird).