return GdipSetClipRegion(real_metafile->playback_graphics, real_metafile->objtable[region].u.region,
(flags >> 8) & 0xf);
This clip region needs to be intersected with the clip region from when the metafile began playing, similar to what we do for world transforms.
Alternately, we could try to repurpose our existing code for handling gdi32 clipping and transforms.
It just occurred to me that applications could tell the difference between those approaches, so we should probably have tests.