Italy shattered as distraught players left in tears after missing World Cup for third straight time - See Photos

The Italian players stood stunned at the final whistle, struggling to process yet another setback as they missed out on the World Cup for a third straight time.

Italy, four-time champions, will once again miss the FIFA World Cup - for the third straight time, after they suffered a nervy defeat to Bosnia and Herzegovina in the qualification play-off final. It was another poor show from Italy as they failed to hold on to their nerves when it mattered the most, only to extend their World Cup exile.

Italy's Marco Palestra, left, and Leonardo Spinazzola console each other after losing a penalty shootout. (AP)

Italy started strongly and took the lead through Moise Kean in the 15th minute, but when the pressure started mounting on them, they just crumbled under it, with Alessandro Bastoni being sent off for chopping down Amar Memic four minutes before half-time, which was a key reason behind it. Meanwhile, Haris Tabakovic pulled Bosnia back in the game with an equaliser in the 79th minute to take the match to extra time.

Italy’s misery deepened in the shoot-out as Francesco Pio Esposito blazed their opening penalty over, setting the tone for what followed. Bryan Cristante then struck the bar, and when Esmir Bajraktarevic squeezed his effort under Gianluigi Donnarumma, the contest had effectively slipped away.

Goalkeeper Gianluigi Donnarumma was dejected after the match Italy failed to qualify for the FIFA World Cup.

The Italian players were in disbelief after what happened to them, as they missed out on the World Cup for the third straight time.

After the shootout loss to Bosnia, Marco Palestra and Leonardo Spinazzola were seen consoling each other.

Pio Esposito was left downcast after missing his chance in the shootout.

Italian midfielder Sandro Tonali was seen crying as his team faltered against Bosnia in the FIFA World Cup qualifier.

"I don't think the boys deserved to suffer such a blow, for the performance, the effort and the heart that they showed tonight... I'm proud of the boys," said Italy coach Gennaro Gattuso.

Gattuso added that talking about his future "wasn't important" but there will be reflection from the football federation as Italy are the first World Cup winners to miss out on three consecutive editions of the tournament, which this year will be held in the United States, Canada and Mexico.

Bosnia striker Edin Dzeko consoled Italy's Bryan Cristante after a penalty shootout as Italy missed out on the FIFA World Cup once again.

The defeat will raise questions about the status of Gattuso, who took over from the fired Luciano Spalletti in June with the squad already in crisis mode following a defeat at Norway in its opening qualifier.

Bosnia fans invaded the pitch after a historic victory which helped them reach the FIFA World Cup.

Bosnia secured a spot at the World Cup for just the second time, and their first since 2014, as an ecstatic crowd entered onto the pitch to celebrate the memorable win.