MATCH REPORT: Italy 0 Uruguay 1
Luis Suarez was at the centre of another biting storm as Uruguay booked their place in the last 16 thanks to a late goal from defender Diego Godin.
The Liverpool striker, banned for ten games for biting Chelsea's Branislav Ivanovic in a Premier League game in 2013, appeared to do likewise to Italy defender Giorgio Chiellini's shoulder as the pair tussled in the box.
With World Cup progression on the cards for both sides, the first half was a tight affair and boiled over after the restart when Claudio Marchisio went in hard on Egidio Rios and was shown a straight red card.
Suarez escaped similar punishment and went on to celebrate with Godin as the defender rose highest from a corner to score the crucial goal with nine minutes remaining, sending Uruguay into the next round and Italy – who needed just a point – home.
With so much on the line for both teams the opening exchanges of this clash featured some heavy challenges, with Mario Balotelli and Uruguay duo Edinson Cavani and Suarez on the end of some robust challenges.
It took 12 minutes for the first real effort on target as Andrea Pirlo chanced his luck from a long-range free-kick which Fernando Muslera palmed over his crossbar.
Balotelli was the first player to go into referee Marco Rodriguez's book on 23 minutes after a high challenge on Alvaro Pereira, meaning the striker would have missed Italy's next game had they progressed.
And just moments later the game almost got worse for Balotelli and co as Pereira got in behind the Italian defence; however Cavani failed to fins the target from the low cross.
It was Italy's turn to try and break the deadlock next as Ciro Immobile found himself unmarked inside Uruguay's penalty area; however his snap shot sailed high and over the bar.
Suarez suddenly burst to life on 34 minutes and after a lovely one-two Italian goalkeeper Gianluigi Buffon spilled his effort before getting up to deny Nicola Lodeiro.
The game crept towards half-time with the only other note of the half coming with an audacious effort from inside his own half from Uruguayan defender Martin Caceres.
The second-half started much like the first with both teams battling for possession, Italy surviving a penalty shout as Leonardo Bonucci wrestled Cavani to the ground.
The deadlock was almost broken on 58 minutes as Cristian Rodriguez played a great one-two with Suarez only to drag his half-volley across goal from just outside the six-yard box.
But while that was bad news for Uruguay just a minute later they were boosted as Marchisio saw a straight red card after raking his studs down Rios' shin.
Suarez almost capitalised on the man advantage on 65 minutes as he poked an effort towards goal after the ball had fallen kindly for him on the edge of the box, however Buffon got down smartly to his right to turn it away for a corner.
If that was the good of the striker then he demonstrated the bad ten minutes later as he appeared to bite Chiellini on the shoulder in a tussle inside the area.
No action was taken and moments later Uruguay found themselves in front as Godin rose highest from a corner to find the back of the net with his shoulder.
And try as they might Italy couldn't find the goal for the sole point they needed to progress, Uruguay now waiting to see if they will face Colombia, Ivory Coast or Japan in the next round.
Italy (3-5-2): Buffon, Chiellini, Bonucci, Barzagli, De Sciglio, Marchisio, Pirlo, Verratti (Motta 75), Darmian, Immobile (Cassano 71), Balotelli (Parolo 46). Subs not used: Sirigu, Candreva, Abate, Cerci, Aquilani, Paletta, Insigne, De Rossi, Perin.
Uruguay (4-3-3): Muslera, Caceres, Gimenez, Godin, Pereira (Stuani 63), Gonzalez, Arevalo Rios, Rodriguez (Ramirez 78), Lodeiro (Maxi Pereira 46), Cavani, Suarez Subs not used: Munoz, Fucile, Gargano, Hernandez, Forlan, Perez, Coates, Lugano, Silva.
Referee: Marco Rodriguez.
Attendance: 39,706.