" It's an idiom. If you're carrying heavy groceries in a paper or plastic bag, and the bottom suddenly drops out of the bag, we often say that the bottom split out of the bag. The word "split" usually describes the situation in which the torn pieces still remain attached to the bag.
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Peymandsthe writer has wanted to say that his stomach is torn?No. He's analyzing the "madness" in the old man, and fearing that he may eventually suffer the same fate.