The card shows a boy throwing up all of his organs.
An expression of the slang phrase "to puke one's guts up," meaning to vomit profusely. It can also be a reference to the slang phrase "spill one's guts," meaning to confess something originally kept secret.
The card was originally going to be released in Old Series 16 as #660. a.TAD Ill/b.Spillin' GUS. The series was later scrapped.