In the first-person killer fantasy, the players take on the role of a man escaping from an insane asylum, AP reports.
Made for the Nintendo Wii, Sony PlayStation Portable and PlayStation 2, the blood-drenched game has been sparking controversy since June, when the Entertainment Software Rating Board gave it a rating of "adult only" that would have excluded it from some big-box retailers, including Wal-Mart Stores Inc.
Producers at Rockstar Games submitted a modified version of "Manhunt 2" later in the summer that got the "mature" rating in August.
"This is a very clear and firm warning to parents that the game is in no way intended for children," the ESRB said in a statement.
The British Board of Film Classifications banned the title and maintained the ban on the modified version. It said the changes don't "go far enough."
"The impact of the revisions on the bleakness and callousness of tone, or the essential nature of the gameplay, is clearly insufficient," the BBFC wrote. "There has been a reduction in the visual detail in some of the 'execution kills,' but in others they retain their original visceral and casually sadistic nature."
"In my opinion, it's the most senselessly violent and offensive thing I've ever watched," said James Steyer, CEO of Common Sense Media, a nonprofit group that advises parents about television, movies, Internet sites and video games that may be inappropriate for children.
A version circulating on the Internet contains more violence and sexually explicit content than the one being released commercially, including a scene where a man's testicles are mutilated with a pliers.
"It's disgusting," Steyer said. "It's so violent, it struck me personally as pornographic violence."
A spokesman for New York-based Take-Two Interactive Software Inc. said the unrated version used a color encoding system common to Western Europe and could be played in the United States only using a Sony PlayStation 2 console modified without company permission.
"The claim that an unreleased version of Manhunt is readily available on the Internet, and that children can easily download and play the unrated game, has not been proven," Take-Two's Ed Nebb wrote in an e-mail.
Professional gamers who reviewed the original and modified titles, which last 40 hours, say the original and the free download include a scene in which a character pummels someone's neck with a shovel that doesn't appear to have made the official cut — though the official game does allow players to use shovels as instruments of torture.
Similarly, the pliers-and-genitalia scene isn't in the official version, but players may use pliers to torture.
The Take-Two spokesman acknowledged that "Manhunt 2" was meant "specifically for those players mature enough to appreciate it."
"Take-Two believes in freedom of creative expression. We also believe in social responsibility," Nebb wrote. "Not all of our products are intended for all consumers and we responsibly market our mature products to adults. We firmly believe that informed adults should be able to make their own choices about entertainment products for themselves and their families."