Defender Diego Godin scored a dramatic winner nine minutes from time to send Uruguay through to the World Cup last 16 with a 1-0 win over Italy on Tuesday (local time) which sent the four-times champions home.
The Italian players were still complaining to the referee after Uruguay striker Luis Suarez appeared to bite Giorgio Chiellini shortly before Godin rose to head in the winner.
The match was sparked into life just before the hour mark when Italy's Claudio Marchisio was shown a straight red card for a foul on Egidio Arevalo Rios.
Before that, it looked like Italy would succeed in suffocating Suarez and the Uruguayan attack and secure the point they needed to progress along with group winners Costa Rica.
After 81 minutes, though, Godin rose above a scrum of players in the Italy box to power the ball into the net off his head and shoulder and give the Uruguayans a lead they never relinquished.
Italy, who had sat back in numbers before Marchisio's dismissal, poured forward to try to rescue the situation but Andrea Pirlo's 85th-minute free kick was their best chance and Uruguay goalkeeper Fernando Muslera swept it around the post.
Italy coach Cesare Prandelli had made his intentions clear by starting with a 3-5-2 formation and for most of the first hour they succeeded in shackling the Uruguayans.
It was a brilliant if often brutal display of the art of defence from the Italians, who, when they lost possession, swarmed around the Uruguay players and fouled them with monotonous regularity.
Suarez was successfully subdued for the most part, Italian goalkeeper Gianluigi Buffon getting a hand to his cut back in the first half and saving well when he was put through on goal after 66 minutes.
Italy had looked lively in midfield but the untested partnership of Mario Balotelli and Ciro Immobile did not gel and the former was withdrawn for midfielder Marco Parolo.