Background <p>Diverticulitis is a common emergency department (ED) diagnosis requiring imaging for confirmation. Point-of-care ultrasound (PoCUS) has emerged as a rapid and accessible modality for evaluating acute abdominal conditions. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of PoCUS in detecting acute diverticulitis. As a secondary objective, we evaluated its accuracy in diagnosing complicated diverticulitis.</p> Methods <p>We performed a systematic review and meta-analysis in accordance with PRISMA-DTA guidelines. MEDLINE, Scopus, Web of Science, and CENTRAL were searched through February 2025, and risk of bias was assessed using QUADAS-2. The reference standard was computed tomography (CT) with or without intravenous contrast or comprehensive clinical follow-up. A bivariate random-effects model was used for pooled estimates.</p> Results <p>Six studies (<i>n</i> = 1,420) evaluating PoCUS performed by emergency physicians or other non-radiologist clinicians were included. Pooled sensitivity and specificity of PoCUS for acute diverticulitis were 94% (95% CI: 92–95%) and 86% (95% CI: 72–94%), respectively. Emergency physician-performed PoCUS showed improved specificity (91%, 95% CI: 88–94%) with similar sensitivity (94%, 95% CI: 91–95%). For complicated diverticulitis, PoCUS demonstrated high specificity (98%, 95% CI: 97–99%) but moderate sensitivity (58%, 95% CI: 46–69%). </p> Conclusion <p>PoCUS is a highly effective diagnostic tool for diverticulitis, offering high sensitivity and specificity. It serves as a practical first-line imaging modality and may reduce reliance on CT imaging. However, due to its moderate sensitivity for complications, confirmatory imaging such as CT is recommended when complications are suspected.</p> Trial registration <p>PROSPERO (CRD42025648563).</p>