Uruguay led 17-7 and good for the Rugby World Cup’s first shock.
But captain Andrés Vilaseca was given a harsh yellow for a high tackle and the difference between Italy, aiming for the quarterfinals, and Uruguay, aiming for a rare Rugby World Cup win, became sharply evident.
Italy pounced with four tries in 15 minutes to earn the precious bonus point and a fourth straight test win for the first time since 1994.
“It was a really tough game,” captain Michele Lamaro said. “I told all the Uruguayan guys they can be proud of their performance, they put us under a lot of pressure but in these moments, what counts the most is how strong is the team, and in the second half we showed that and smashed everything we could.
“I’m really proud of the boys and I’ll share this moment for the rest of my life with them.”
Italy took the lead from Uruguay in the seventh minute when wing Lorenzo Pani took crash ball off a scrum and scored on his Rugby World Cup debut.
Uruguay flyhalf Felipe Etcheverry dragged his first two penalty kicks wide and intercepted Lamaro but was dragged down short of the tryline by opposite Tommaso Allan.
But Italy was under pressure on its line and lock Niccolò Cannone was yellow-carded for a cynical foul. Moments later, Uruguay mauled over the line and Italy prop Danilo Fischetti was ruled to have collapsed it. A penalty try was awarded and Fischetti joined Cannone in the sin-bin.
Uruguay exploited the two-man advantage just before it ended when Etcheverry offloaded for a corner try by wing Nicolas Freitas, who by then had been playing with a broken nose for 25 minutes.
Etcheverry converted from the touchline and added a 45-meter drop goal with the last kick of the half to send Uruguay racing off the field with a 17-7 halftime lead.
The match turned again at the start of the second half when Vilaseca was sin-binned. Italy made the man advantage count.
Hooker Giacomo Nicotera was held up by Uruguay scrumhalf Santiago Arata, but two minutes later Lamaro bashed through three defenders to score his first test try. Lamaro was quickly followed with tries by wing Montanna Ioane after a chargedown by Allan, and No. 8 Lorenzo Cannone while Uruguayans were hanging off him.
With bonus-point try banked, Italy hammered the Uruguay line and Paolo Garbisi fed midfield partner Juan Ignacio Brex into a gap to score their fifth try.
Allan added the extras as usual. He has slotted 13 goalkicks without a miss in two games. When he was rested, Garbisi took over to nail a late penalty kick.