Background: Acute abdomen is a common reason for emergency department consultations, with acute diverticulitis frequently affecting elderly patients. To reduce the number of CT scans, many centers use systematic ultrasound as the first-line imaging method. The accuracy of point-of-care ultrasound (POCUS) for diagnosing acute diverticulitis by emergency physicians remains largely unexamined. This retrospective study aims to assess ultrasound’s effectiveness as the initial diagnostic tool for suspected cases. Methods: We conducted a retrospective analysis at the University Hospital Bern, Switzerland, from 2012 to 2019, where ultrasound was used as the primary imaging for suspected diverticulitis. We compared the characteristics of conclusive ultrasound exams with CT scans, the gold standard. Results: Out of 705 patients screened, 609 (86%) were excluded due to various reasons, leaving 96 (14%) for analysis. Among these, 48 had conclusive ultrasound exams while 48 had inconclusive results. The overall accuracy of POCUS for diverticulitis was 79%. Experienced sonographers had a significantly higher accuracy of 92%, compared to 64% for inexperienced examiners. The rate of inconclusive exams was also lower among experienced providers. Discussion: POCUS showed limited sensitivity for detecting diverticulitis, particularly in less experienced hands. The high rate of inconclusive exams (50%) remains concerning, emphasizing the need for enhanced training and standardization. Conclusion: While POCUS can be effective for experienced examiners, its limitations necessitate further imaging in inconclusive cases. Training and standardized protocols are essential for improving diagnostic accuracy, though the study’s limitations highlight the need for cautious interpretation.