Defender Diego Godin scored a dramatic winner nine minutes from time to give Uruguay a 1-0 victory over Italy which sent the South Americans through to the last 16 and the four-times champions home.
Italy played the last half hour with 10 men after Claudio Marchisio was harshly sent off and their sense of grievance will only be exacerbated by an apparent bite on Giorgio Chiellini by Uruguay striker Luis Suarez shortly before Godin's goal.
Until Marchisio's dismissal, it looked like Italy would succeed in suffocating Suarez and the Uruguay attack and secure the point they needed to progress along with group winners Costa Rica.
Godin's goal meant Uruguay, semi-finalists four years ago, advanced to a clash with the Group C winners in Rio de Janeiro but they might be without talismanic striker Suarez who could face disciplinary action.
Suarez and Chiellini clashed in the Italian penalty area 10 minutes from the end and the furious Italian pulled open his shirt to show the mark to the referee. Reuters photographs show what appeared to be bite marks on his shoulder.
"It was ridiculous not to send Suarez off," Chiellini told Rai TV.
"It is clear, clear-cut and then there was the obvious dive afterwards because he knew very well that he did something that he shouldn't have done."
Suarez was banned for 10 games last year after biting Chelsea's Branislav Ivanovic in a Premier League game and in 2010 he was suspended for seven games for biting an opponent while playing for Ajax Amsterdam.
Italy coach Cesare Prandelli had made his intentions clear by starting with a 3-5-2 formation and for most of the first hour the Azzurri succeeded in shackling the Uruguayans.
It was a brilliant if often brutal display of the art of defending 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 and when he did break free from his minders, Italian goalkeeper Gianluigi Buffon got a hand to his cut back in the first half and saved well when he was put through on goal after 66 minutes.
Italy had withdrawn striker Mario Balotelli at halftime for another midfielder in Marco Parolo, an indication that coach Cesare Prandelli would be satisfied if the 39,706 crowd was to leave the Dunas arena without seeing a goal.
Italy's midfield was back down to first-half numbers after 59 minutes, though, when Marchisio went over the ball and caught Egidio Arevalo Rios on the knee and was shown a straight red card.
The ill-tempered match had just boiled over again after the bite allegation when Godin, Uruguay's stand-in captain, rose above a scrum of players in the Italy box to power Gaston Ramirez's corner into the net off his head and shoulder.
Italy 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 was equal to it.